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Full text of "Choosing a Medigap policy : ... guide to health insurance for people with Medicare"

CENTERS FOR MEDICARE & MEDICAID SERVICES 

2006 

Choosing a Medigap Policy: 

A Guide to Health Insurance 
for People With Medicare 




PUBS 

RA 

412 

.3 

C66 

2006 



This official government guide can help you 

* Learn what a Medigap (Medicare Supplement 
Insurance) policy is. 

* Decide if you want to buy a Medigap policy. 

* Understand when you can buy a Medigap policy. 

* Choose the Medigap policy that best meets 
your needs. 

* Understand how Medigap policies have changed 
since Medicare prescription drug coverage started. 

* Know where to go if you have questions. 

Important: Turn to Section 4 if you have a Medigap policy that 
includes prescription drugs. You will need to make 
a decision about Prescription Drug Coverage. 

Developed jointly by the Centers for Medicare & Medicaid Services (CMS) 
and the National Association of Insurance Commissioners (NAIC) 



How to use this Guide 

There are two ways to find the information you need: 

1. The "Table of Contents" on pages 1-2 can help you find 
the sections you need to read. 

2. The "List of Topics" on pages 94-97 lists every topic in 
this guide and the page number to find it. 

Who should read this Guide 

This guide was written to help people with Medicare 
understand Medigap (Medicare Supplement Insurance) policies. 

A Medigap policy is a type of private insurance that helps you 
pay for some of the costs that Original Medicare doesn't pay for. 
This guide explains in detail how Medigap policies work. It also 
includes information about Medicare drug plans and how the 
availability of these plans has changed Medigap policies. . 

If you have a Medigap policy with prescription drug coverage, 
you should read pages 39—40. 



The "2006 Choosing a Medigap Policy: A Guide to Health Insurance for People 
With Medicare" isn't a legal document. The official Medicare Program and 
Medigap provisions are contained in the relevant laws, regulations, and rulings. 



lhUUM*«MaW-U 



^.o j Section 1: How Have Medicare and Medigap Policies Changed? 

,CGk What's Changed in Medicare? 4 

What's Changed in Medigap policies? 5 

c % 

Section 2: Medicare Overview 

What is Medicare? 8 

What is Medicare Part A? 8 

What is Medicare Part B? 8 

What is Medicare prescription drug coverage? 8 

What are Medicare Plans? 9 

Original Medicare Plan and Medigap policies at a glance 9-10 

Medicare Advantage Plans and other Medicare Health Plans at a glance .... 10 

Section 3: What You Need to Know About Medigap Policies 

What Medigap is and isn't 12-14 

Why would I want to buy a Medigap policy? 14—15 

Who can buy a Medigap policy? 16 

Can I keep seeing the same doctor if I buy a Medigap policy? 16 

What is Medicare SELECT? 16 

What Medigap policies don't cover 16 

How Medigap Plans A through J differ from Medigap Plans K and L .... 17 

What Medigap policies cover 18 

Basic Benefits for Medigap Plans A through J 18 

Basic Benefits for Medigap Plans K and L 19 

Overview of Medigap Plans A through J 20 

Overview of Medigap Plans K and L 21 

Information on Medigap costs 22—25 

How much policies cost, ways of pricing Medigap policies, 

and what can affect the cost 
Buying a Medigap policy 26-28 

Best time to buy and information on Medigap 

Open Enrollment Period 

Pre-existing conditions 29 

Creditable coverage (past health care coverage) 30—31 

Switching Medigap policies 32 

Losing Medigap coverage 33 Continued 

How your bills get paid. 34 on next 

Illegal insurance practices 35 P a g e ^ 

Reliable insurance companies 36 

1 



Section 4: Prescription Drug Coverage Overview 

Medicare Prescription Drug Coverage 38 

Medigap Policies and Medicare Prescription Drug Coverage 38-40 

Section 5: Steps to Buying a Medigap Policy 

Steps to buying a Medigap policy 42-52 

Section 6: Medigap Rights and Protections 

Medigap rights and protections (guaranteed issue rights) 54-63 

Section 7: Medigap Policies and Disability or ESRD 

Information on disability and End-Stage Renal Disease 66-68 

Section 8: Other Ways to Pay Health Care Costs 

Other kinds of insurance and ways to pay health care costs 70-77 

Section 9: Massachusetts, Minnesota, and Wisconsin 
Medigap Plans 

Information for Massachusetts 80 

Information for Minnesota 81 

Information for Wisconsin 82 

For information about Medigap policies sold in other states, 

see pages 1 9 and 2 1 . 

Section 10: For More Information 

Where to get information 84 

Where to call with Medicare questions 84 

Important telephone numbers for each state 85—86 

Section 1 1 : Words to Know 

Where words in green are defined 88-91 

Section 12: List of Topics 

An alphabetical list of what is in this Guide 94—97 




Section 1 



How Have Medicare 
and Medigap 
Policies Changed? 



Section 1: How Have Medicare and Medigap Policies Changed? 



Words in green 
are defined on 
pages 88-91. 



Below is a quick look at changes to the Medicare Program and 
Medigap policies. 

What's Changed in Medicare? 

A new Federal law has brought many changes to the Medicare 
Program. These changes give you even more choices in how you get 
your health care benefits, including coverage for prescription drugs. 

Medicare prescription drug coverage — Started in 2006 

Medicare now offers prescription drug coverage, which is described 
in more detail starting on page 38. 

• If you join a Medicare drug plan by May 15, 2006, you can still 
get Medicare drug coverage for 2006. 

• If you wait until after May 15, 2006, to join a Medicare drug plan, 
you may have to pay a penalty (higher premium), and in most cases 
you won't be able to join a Medicare drug plan until 
November 15— December 31 of any year. Your Medicare drug 
coverage would begin January 1 of the following year. 

Medicare Advantage Plans and Other Medicare Health Plans 

Medicare Advantage Plans and other Medicare Health Plans now 
offer a wider variety of plans to choose from for your health care 
coverage, including prescription drug coverage in more areas of the 
country. See page 10 for more details. 

Where can I get more information about the 
changes in Medicare? 

To learn more about Medicare, get a free copy of the "Medicare & 
You" handbook (CMS Pub. No. 10050) by visiting 
www.medicare.gov on the web. Select "Search Tools" at the top of the 
page. This website also includes information on what Medicare health 
plans, Medicare drug plans, and Medigap policies are available in your 
area. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users ' 
should call 1-877-486-2048. 



Section 1: How Have Medicare and Medigap Policies Changed? 



If you live in 
Massachusetts, 
Minnesota, or 
Wisconsin, see 
pages 80-82. 



Note: Medigap 
policies with 
prescription 
drugs aren't 
Medicare drug 
plans. 



What's Changed in Medigap (Medicare 
Supplement Insurance) policies? 

Federal law now gives you more choices in Medigap policies. 
In addition to Medigap Plans A through J, two new Medigap 
policies are available (Medigap Plans K and L). Below is a quick look 
at the two new Medigap policies. 

Medigap Plans K and L offer 

• fewer benefits than Medigap Plans A through J. 

• lower premiums than Medigap Plans A through J. 

If you use the benefits in Medigap Plans K and L, you will have to 
pay higher out-of-pocket costs than Medigap Plans A through J. 

To learn about the types of benefits that Medigap Plans K and L 
offer, see pages 1 9 and 2 1 . 

For more information about how Medigap Plans A through J differ 
from Medigap Plans K and L, see page 17. 

Note: If you bought your Medigap policy before 1992 or live in 
Massachusetts, Minnesota, or Wisconsin, your Medigap policy may 
be called something different than "Medigap Plans A through L." 

Changes to Medigap policies with prescription drug coverage 

The new Federal law that provided for Medicare to start offering 
prescription drug coverage on January 1, 2006, also made changes 
that affected Medigap policies that include prescription drug 
coverage. 

• As of January 1, 2006, you can't buy a new Medigap policy 
covering prescription drugs. 

• If the Medigap policy that you have now covers prescription drugs, 
you should have received detailed information in the mail from 
your Medigap insurance company about your drug options (see 
page 39 and Situation #8 on page 62). You need to decide by 
May 15, 2006, which drug option meets your needs. For help 
making your decision, visit www.medicare.gov on the web, or call 
1-800-MEDICARE (1-800-633-4227). TTY users should call 
1-877-486-2048. 



Section 1: How Have Medicare and Medigap Policies Changed? 



Where can I get more information 
about the changes in Medigap policies? 

If you have questions about Medigap policies, you can visit 
www. medicare. gov on the web. Or, call 1-800-MEDICARE 
(1-800-633-4227). TTY users should call 1-877-486-2048. You 
can also call your State Health Insurance Assistance Program (see 
pages 85-86). 



Words in green 
are defined on 
pages 88-91. 




Section 2 



Medicare Overview 



Section 2: Medicare Overview 



Words in green 
are defined on 
pages 88-91. 



8 



Before you decide whether or not to buy a Medigap policy, there are a 
few things you should know about the Medicare Program and Medicare 
plans (the different ways you can get your Medicare coverage). The next 
few pages give you a quick look at Medicare plans and how Medigap 
policies might work or not work with these plans. 

If you already know the basics about the Medicare Program and 
Medicare plans, turn to Section 3 "What You Need to Know About 
Medigap Policies," which starts on page 11. 

If you want to learn more about the new Medicare prescription drug 
coverage and how this coverage affects Medigap policies, read Section 4 
"Prescription Drug Coverage Overview," which starts on page 38. 

What is Medicare? 

Medicare is a health insurance program for 

• people age 65 or older, 

• people under age 65 with certain disabilities, and 

• people of all ages with End-Stage Renal Disease (permanent 
kidney failure requiring dialysis or a kidney transplant). 

Medicare has 

• Part A (Hospital Insurance), 

• Part B (Medical Insurance), and 

• prescription drug coverage. 

What is Medicare Part A? 

Medicare Part A helps cover your inpatient care in hospitals, including 
critical access hospitals, and skilled nursing facilities (not custodial or 
long-term care). It also helps cover hospice care and some home health 
care. You must meet certain conditions to get these benefits. 

What is Medicare Part B? 

Medicare Part B helps cover your doctors' services and outpatient care. 
It also covers some other medical services that Medicare Part A doesn't 
cover, such as some of the services of physical and occupational 
therapists, and some home health care. These services are covered when 
they are medically necessary. 

What is Medicare prescription drug coverage? 

Medicare started offering coverage for prescription drugs on January 1 , 
2006. For more details about this coverage, see Section 4 on pages 38-40. 



ection 



.edicare Overview 



Note: Medigap 
policies aren't 
Medicare 
Advantage Plans 
or other 

Medicare Health 
Plans. 



What are Medicare Plans? 

Medicare plans are the different ways you can get your health care and 
prescription drug coverage in the Medicare Program. Your Medicare plan 
choices include the following: 

• The Original Medicare Plan — Available nationwide. If you have this 
plan, you may want to buy a Medigap policy. 

• Medicare Advantage Plans — Available in many areas. If you have one of 
these plans, you don't need, and generally can't use a Medigap policy. 
Medicare Advantage Plans include 

■ Medicare Health Maintenance Organization (HMO) Plans 

■ Medicare Preferred Provider Organization (PPO) Plans 

■ Medicare Private Fee-for-Service (PFFS) Plans 

■ Medicare Special Needs Plans 

• Other Medicare Health Plans (that aren't Medicare Advantage 
Plans) — Available in many areas. If you have one of these plans, you 
don't need a Medigap policy. These other types of Medicare Health 
Plans include 

■ Medicare Cost Plans 

■ Demonstrations 

■ PACE (Programs of All-inclusive Care for the Elderly) 

• Medicare Prescription Drug Plans — see pages 38-40. Medicare 
prescription drug coverage started January 1, 2006. 

The Medicare plan that you choose affects many things like cost, benefits, 
doctor and hospital choice, convenience, prescription drugs, and 
pharmacy choices. No matter how you choose to get your health care or 
prescription drug coverage, you are still in the Medicare Program. 

Original Medicare Plan and Medigap policies at 
a glance 

If you get your health care from the Original Medicare Plan, you use your 
red, white, and blue Medicare card (see sample card on page 27). The 
card tells you if you have Medicare Part A, Part B, or both. You don't 
need Medicare Part B to be in the Original Medicare Plan. However, you 
generally must have Medicare Part A and Part B to buy a Medigap policy. 

The Original Medicare Plan pays for many health care services and 
supplies, but it doesn't pay all of your health care costs. There are costs 
that you must pay, like coinsurance, copayments, and deductibles. These 
costs are called "gaps" in Medicare coverage. 



Section 2: Medicare Overview 




Note: If you have 
End- Stage Renal 
Disease, you 
usually can't join a 
Medicare 
Advantage Plan 
(see pages 66—67). 



Important: It is 

illegal for anyone to 
sell you a Medigap 
policy if you 
already have a 
Medigap policy 
(unless you are 
cancelling your old 
Medigap policy). 



Original Medicare Plan and Medigap policies at a 
glance (continued) 

You might want to consider buying a Medigap policy to cover these gaps in 
Medicare coverage. Some Medigap policies also cover benefits that Medicare 
doesn't cover, like Medicare Part B excess charges and emergency health care 
while traveling outside the United States. A Medigap policy may help you 
save on out-of-pocket costs. If you buy a Medigap policy, you will have to pay 
a monthly premium to the private insurance company that sells you the 
Medigap policy. 

Medigap policies only help pay for claims paid through Original Medicare. 
To learn what Medigap policies cover, see pages 43-48. 

Medicare Advantage Plans and other Medicare 
Health Plans at a glance 

If you decide to join a Medicare Advantage Plan or other Medicare Health 
Plan, you will still have a Medicare card. However, you need to use the 
membership card that you get from the plan for your health care. These 
plans often give you extra benefits, like coverage for extra days in the 
hospital, that aren't included under the Original Medicare Plan. 

If Medicare Advantage Plans or other Medicare Health Plans are available in 
your area, and you have Medicare Part A and Part B, you can join one and 
get your Medicare-covered benefits through the plan. You will have to pay 
the monthly Medicare Part B premium ($88.50 in 2006). In addition, you 
might have to pay a monthly premium to your Medicare Advantage Plan or 
other Medicare Health Plan for the extra benefits that they offer. You 
should call the Medicare Advantage Plans or other Medicare Health Plans 
you are interested in for more information. 

If you are in a Medicare Advantage Plan or other Medicare Health Plan, 
you may not want a Medigap policy Medigap policies won't work with 
Medicare Advantage Plans or other Medicare Health Plans. 

Note: If you have a Medigap policy and you join a Medicare Advantage 
Plan or other Medicare Health Plan, you may want to drop your Medigap 
policy. Even though you are entitled to keep it, it can't pay for benefits that 
you get under your Medicare Advantage Plan or other Medicare Health 
Plan and can't pay any cost-sharing under these plans. However, if you drop 
your Medigap policy, and you later leave the Medicare Advantage Plan or 
other Medicare Health Plan, you may not be able to buy a Medigap policy 
with the same benefits or for the same cost. In some cases, you may not be 
able to buy a Medigap policy at all. 



10 




Section 3 



What You Need 
to Know About 
Medigap Policies 




11 



Section 3: What You Need to Know About Medigap Policies 



If you live in 
Massachusetts, 
Minnesota, or 
Wisconsin, 

different types of 
standardized 
Medigap policies 
are sold in your 
state (see pages 
80-82). 



What is a Medigap policy? 

A Medigap policy is health insurance sold by private insurance 
companies to fill the "gaps" in Original Medicare Plan coverage. 
Medigap policies help pay some of the health care costs that the 
Original Medicare Plan doesn't cover. If you are in the Original 
Medicare Plan and have a Medigap policy, then Medicare and your 
Medigap policy will both pay their shares of covered health care costs. 

Insurance companies can only sell you a "standardized" Medigap 
policy. These Medigap policies must all have specific benefits so you 
can compare them easily. 

Since 1992, there have been 10 standardized Medigap policies called 
Medigap Plans "A" through "J." In 2005, two new standardized 
Medigap policies became available, called Medigap Plans "K" and "L." 
You may be able to choose from up to 12 different standardized 
Medigap policies (Medigap Plans A through L). 

Medigap policies must follow Federal and state laws. These laws 
protect you. The front of a Medigap policy must clearly identify it as 
"Medicare Supplement Insurance." Each Medigap Plan, A through L, 
has a different set of basic and extra benefits (see pages 17-21). 

It's important to compare Medigap policies, because costs can vary. 
The benefits in any Medigap Plan A through L are the same for any 
insurance company. (For example, the benefits in one insurance 
company's Medigap Plan C are the same as any other insurance 
company's Medigap Plan C.) Generally, the difference between 
Medigap policies sold by different insurance companies might be 

• how the insurance company sets its own premiums (see pages 22-23), 

• if the Medigap policy is sold as Medicare SELECT (see page 16), and 

• whether there is a pre-existing condition waiting period (see page 29). 

Also, insurance companies that sell Medigap policies don't have to 
offer every Medigap policy (Medigap Plans A through L). Each 
insurance company decides which Medigap policies it wants to sell. 



12 



Section 3: What You Need to Know About Medigap Policies 



Words in green 
are defined on 
pages 88-91. 



What is a Medigap policy? (continued) 

Generally, when you buy a Medigap policy you must have Medicare 
Part A and Part B. You will have to pay the monthly Medicare Part B 
premium ($88.50 in 2006). In addition, you will have to pay a 
premium to the Medigap insurance company. In most cases, as long 
as you pay your premium, your Medigap policy is guaranteed 
renewable. This means it is automatically renewed each year. 
Your coverage will continue year after year as long as you pay 
your premium. 

Important: In some states, insurance companies may refuse to renew 
a Medigap policy bought before 1990. At the time these Medigap 
policies were sold, state law might not have required that Medigap 
policies be guaranteed renewable. 

If you and your spouse both want Medigap coverage, you each must 
buy separate Medigap policies. Your Medigap policy won't cover any 
health care costs for your spouse. 

A Medigap policy only works with the Original Medicare Plan. If you 
join a Medicare Advantage Plan or other Medicare Health Plan, your 
Medigap policy can't pay any deductibles, copayments, or other 
cost-sharing under your Medicare Advantage Plan or other Medicare 
Health Plan. Therefore, you may want to drop your Medigap policy if 
you join a Medicare Advantage Plan or other Medicare Health Plan. 
However, you have a legal right to keep the Medigap policy (see 
Situation #5 on page 60). 



13 



Section 3: What You Need to Know About Medigap Policies 



What types of coverage are NOT 
Medigap policies? 

A Medigap policy is different from 

• Medicare Health Plans, 

• Medicare Part B, 

• Medicare drug plans, 

• Medicaid, 

• an employer or union plan, 

• TRICARE, and 

• Veterans' benefits. 

Why would I want to buy a Medigap policy? 

You may want to buy a Medigap policy because Medicare doesn't 
pay for all of your health care. There are "gaps" or "out-of-pocket" 
costs that you must pay in the Original Medicare Plan. The chart on 
the next page gives some examples of these gaps. A Medigap policy 
will cover some, but not all of the gaps in the Original Medicare Plan. 

If you are in the Original Medicare Plan, a Medigap policy might 
help you 

• lower your out-of-pocket costs, and 

• get more health insurance coverage. 



14 



Section 3: What You Need to Know About Medigap Policies 



Some Examples of Gaps in Medicare-covered Services 


What YOU Pay in 2006 A Medigap policy 

(These amounts can change each year.) may he,p pay 

these costs 


Hospital Stays For each benefit period, YOU PAY 

• $952 for the first 60 days 

• $238 per day for days 61-90 

• $476 per day for days 91-150 (while 
using your 60 lifetime reserve days) 


/ 


Skilled Nursing For each benefit period, YOU PAY 
Facility Stays . Nothing for the first 20 days 

• Up to $119 per day for days 21-100 


/ 


Blood YOU PAY the cost of the first three pints. 


/ 


Medicare Part B YOU PAY the $124 per year deductible. 
Yearly Deductible 


/ 


Medicare Part B YOU PAY 

Covered Services • 20% of the Medicare-approved amount 

for most covered services 

• 50% of the Medicare-approved amount 
for outpatient mental health treatment* 

• Copayment for outpatient hospital services 


/ 



* Medigap Plans A through J must pay 50% coinsurance for outpatient mental 
health treatment services. This percentage is different for Medigap Plans K and L. 

Some Medigap policies also cover other extra benefits that aren't covered by Medicare. 
Some examples of these benefits include 

• routine yearly check-ups (Medicare covers a one-time "Welcome to Medicare" 
physical exam within the first six months of having Medicare Part B) , 

• Medicare Part B excess charges (the difference between your doctor's charge and the 
Medicare-approved amount) that only apply if your doctor doesn't accept 
assignment, 

• and more (see pages 20—21). 



15 



Section 3: What You Need to Know About Medigap Policies 



Who can buy a Medigap policy? 

To buy a Medigap policy, you generally must have Medicare Part A and 
Part B. You are guaranteed the right to buy a Medigap policy if you are 

• in your Medigap open enrollment period (see page 26), or 

• covered under a Medigap protection (see pages 54—63). 
It is illegal for anyone to sell you a Medigap policy if you 

• are in a Medicare Advantage Plan (unless your enrollment is ending). 

• have Medicaid (except in certain situations, see page 75). 

• already have a Medigap policy (unless you are cancelling your old 
Medigap policy). 

If you are under age 65 and you are disabled or have End-Stage Renal Disease 
(ESRD), you might not be able to buy a Medigap policy until you turn age 65. 
More information about Medigap policies for people under age 65 starts on 
page 65. 

Can I keep seeing the same doctor if I buy a 
Medigap policy? 

In most cases, yes. If you are in the Original Medicare Plan and you have a 
Medigap policy, you can go to any doctor, hospital, or other health care 
provider who accepts Medicare. However, if you have the type of Medigap 
policy called Medicare SELECT, you must use specific hospitals and, in some 
cases, specific doctors to get your full insurance benefits. 

What is Medicare SELECT? 

Medicare SELECT is a type of Medigap policy sold in some states. If you buy 
a Medicare SELECT policy, you are buying one of the 12 standardized 
Medigap Plans A through L. However, with a Medicare SELECT policy you 
usually must use specific hospitals and, in some cases, specific doctors to get 
full insurance benefits (except in an emergency). For this reason, Medicare 
SELECT policies generally cost less than other Medigap policies. 

What are some examples of things that are NOT 
covered by Medigap policies? 

• Long-term care 

• Vision or dental care 

• Hearing aids 

• Private-duty nursing 

• Outpatient prescription drugs 

Note: Medigap policies sold before January 1 , 2006, may include prescription 
drug coverage if you aren't enrolled in a Medicare drug plan. 



16 



raffMBflmlFHB 



How do Medigap Plans A through J differ from Medigap 
Plans K and L? 

Medigap Plans A through J offer different benefits than Medigap Plans K and L and have higher 
premiums because they provide more benefits and have lower out-of-pocket costs. Listed below is a 
quick look at how Medigap Plans A through J differ from Medigap Plans K and L. 



Comparing Medigap Policies 




Medigap Plans A through J 


Medigap Plans K and L 


Premiums 


Higher premiums 


Lower premiums 


Out-of-pocket 
costs 


Lower (or no) out-of-pocket costs 


Higher out-of-pocket costs, 
but subject to out-of-pocket 
annual limits (see page 1 9) 


Basic Benefits 


Includes 


Includes 




• Medicare Part A coinsurance 
and hospital benefits 

• Medicare Part B coinsurance 
or copayment 

• Blood 


• Medicare Part A coinsurance 
and hospital benefits 

• Medicare Part B coinsurance 
or copayment 

• Blood 

• Hospice care 




See page 18 for details about these 
basic benefits. 


See page 1 9 for details about 
these basic benefits. 


Extra Benefits 


May include 


Includes 




• Skilled Nursing Facility coinsurance 

• Medicare Part A and B deductibles 

• Medicare Part B Excess Charges 


• Skilled Nursing Facility 
coinsurance 

• Medicare Part A deductible 




• Foreign Travel Emergency 

• At-Home Recovery 

• Preventive Care 






• Note: Medigap policies sold before 
January 1, 2006, may include 
prescription drug coverage. 






See page 20 for details about these 
extra benefits. 


See page 21 for details about 
these extra benefits. 



On the next four pages, you will see four different charts. These charts are side-by-side to 
help you compare the different types of benefits that each Medigap policy offers. The charts 
on pages 18-19 will help you compare the different basic benefits for Medigap Plans A 
through J with Medigap Plans K and L. See pages 20-21 to compare the different extra 
benefits for Medigap Plans A through J with Medigap Plans K and L. 



17 



ection 3: What You Need to Know About Medigap P< 



What do Medigap policies cover? 

Each standardized Medigap policy must cover basic benefits. 
Medigap Plans A through J have one set of basic benefits, and 
Plans K and L have a different set of basic benefits (see the basic 
benefits charts below for Medigap Plans A through J, and page 19 
for Medigap Plans K and L). Most Medigap policies pay some, if not 
all, of the Original Medicare Plan coinsurance and outpatient 
copayment amounts. These policies may also cover Original 
Medicare Plan deductibles. Some Medigap policies cover extra 
benefits to help pay for things Medicare doesn't cover (see the extra 
benefits charts on page 20 for Medigap Plans B through J, and page 21 
for Medigap Plans K and L). 



If you live in 
Massachusetts, 
Minnesota, or 
Wisconsin, see 
pages 80-82. 



Note: Medigap Plans F and J have a high-deductible option (see 
page 24). If you choose this option, you must pay this deductible 
first before the Medigap policy pays anything. 



A Quick Look at the 
Basic Benefits for Medigap Plans A through J 


Basic benefit What Medigap Plans A through J pay in 2006 

(These amounts can change each year.) 


Medicare Part A 
coinsurance and 
hospital benefits 


Medigap Plans A through J pay 

• $238 per day for days 61-90 of a hospital stay 

• $476 per day for days 91-150 of a hospital stay (while using 
your 60 lifetime Medicare-covered days) 

• Up to 365 more days for hospital stays during your lifetime 
after you use all Medicare hospital benefits 


Medicare Part B 
coinsurance or 
copayment 


Medigap Plans A through J pay all coinsurance and 
copayment amounts after you meet the $ 1 24 yearly deductible 
for Medicare Part B. 


Blood 


Medigap Plans A through J pay for the first three pints of 
blood or equal amounts of packed red blood cells per calendar 
year, unless you or someone else donates blood to replace 
what you use. 



See pages 20, 43, and 46-47 for more information about Medigap Plans A through J. 



18 




™aaa™«EpiB1 



A Quick Look at the 
Basic Benefits for Medigap Plans K and L 


Basic benefit What Medigap Plans K and L pay in 2006 

(These amounts can change each year.) 


Medicare Part A 
coinsurance and 
hospital benefits 


Medigap Plan K and Medigap Plan L pay 

• $238 per day for days 61-90 of a hospital stay 

• $476 per day for days 91-150 of a hospital stay (while 
using your 60 lifetime Medicare-covered days) 

• Up to 365 more days of a hospital stay during your 
lifetime after you use all Medicare hospital benefits 


Medicare Part B 
coinsurance or 
copayment 


Medigap Plan K pays 50% of the Medicare Part B 
coinsurance after you meet the $124 yearly deductible for 
Medicare Part B. It pays 100% of the coinsurance for 
Medicare Part B preventive services. 

Medigap Plan L pays 75% of the Medicare Part B 
coinsurance after you meet the $124 yearly deductible for 
Medicare Part B. It pays 100% of the coinsurance for 
Medicare Part B preventive services. 


Blood 


Medigap Plan K pays 50% of the first three pints of blood 
or equal amounts of packed red blood cells per calendar year, 
unless you or someone else donates blood to replace what 
you use. 

Medigap Plan L pays 75% of the first three pints of blood 
or equal amounts of packed red blood cells per calendar year, 
unless you or someone else donates blood to replace what 
you use. 


Hospice care 


Medigap Plan K pays 50% of the hospice cost-sharing for all 
Medicare Part A Medicare-covered expenses and respite care. 

Medigap Plan L pays 75% of the hospice cost-sharing for all 
Medicare Part A Medicare-covered expenses and respite care. 



Note: Medigap Plan K has a $4,000 out-of-pocket annual limit. Medigap Plan L has a 
$2,000 out-of-pocket annual limit. Once you meet the annual limit, the plan pays 100% of 
the Medicare Part A and Part B copayments and coinsurance for the rest of the calendar year. 
Charges from your doctor that exceed Medicare-approved amounts, called "excess char£ ss," 
aren't covered and don't count toward the out-of-pocket limit. You will have to pay these 
excess charges. The out-of-pocket annual limit can increase each year because of inflation. 

See pages 21, 44-45, and 48 for more information about Medigap Plans K and L. 



19 





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21 



Section 3: What You Need to Know About Medigap Policies 



How much do Medigap policies cost? 

The cost of Medigap policies can vary widely. There can be big 
differences in the premiums that different insurance companies 
charge for exactly the same coverage. As you shop for a Medigap 
policy, be sure you are comparing the same Medigap policy. (For 
example, compare a Medigap Plan C from one insurance company 
with Medigap Plan C from another insurance company.) Although 
this guide can't give actual costs of Medigap policies, you can get this 
information by calling insurance companies. Or, you can call your 
State Health Insurance Assistance Program (see pages 85-86). 

You can also find out which insurance companies sell Medigap 
policies in your area by visiting www.medicare.gov on the web. Select 
"Search Tools" at the top of the page, then select "Compare Health 
Plan Options in Your Area." See page 49 for more details. 

How do insurance companies set the price of 
Medigap policies? 

Each insurance company sets its own premiums. It is important to ask 
how an insurance company prices Medigap policies. How they set the 
price affects how much you pay now and in the future. Medigap 
policies can be priced or "rated" in three ways: 

1. Community-rated (or "no-age-rated") 

2. Issue-age-rated 

3. Attained-age-rated 

Each of these ways of pricing Medigap policies is described in the 
chart on the next page. Monthly premiums may vary by insurance 
company and by Medigap policy. The amounts in the examples aren't 
actual costs. Only you can choose the insurance company that best 
meets your needs. Remember, you should look at how much the 
Medigap policy will cost you now and in the future. 



22 



Section 3: What You Need to Know About Medigap Policies 



How Insurance Companies Set Prices for Medigap Policies 



Type of 
pricing 



Community- 
rated 

(also called 
no-age-rated) 



How it's 
priced 



The same 
monthly 
premium is 
charged to 
everyone who 
has the 

Medigap policy, 
regardless 
of age. 



What pricing may Examples 
mean for you 



Premiums are the same no 
matter how old you are. 
Premiums may go up 
because of inflation. 



Mr. Smith is age 65. He buys a 
Medigap policy and pays a $165 
monthly premium. 



Mrs. Perez is age 72. She buys the 
same Medigap policy as Mr. Smith. 
She also pays a $ 1 65 monthly 
premium because with this type of 
Medigap policy, everyone pays the 
same price, regardless of age. 



Issue-age- 
rated 



The premium is 
based on the 
age you are 
when you buy 
(are "issued") 
the Medigap 
policy. 



Premiums are lower for 
younger buyers. Premiums 
may go up because of 
inflation. 



Mr. Han is age 65. He buys a 
Medigap policy and pays a $145 
monthly premium. 



Mrs. Wright is age 72. She buys the 
same Medigap policy as Mr. Han. 
Since she is older at the time she buys 
it, her monthly premium is $175. 



Attained-age- 
rated 



The premium is 
based on your 
current age (the 
age you have 
"attained") so 
your premium 
goes up each 
year. 



Premiums for these 
Medigap policies are low for 
younger buyers, but go up 
every year and can 
eventually become the most 
expensive. Premiums may 
also go up because of 
inflation. 



Mrs. Anderson is age 65. She pays a 
$165 monthly premium. Her 
premium will go up every year. 

• At age 66, her premium goes 
up to $171 

• At age 67, her premium goes 
up to $177 

• At age 72, her premium goes 
up to $189 



Mr. Dodd is age 72. He buys the 
same Medigap policy as Mrs. 
Anderson. He pays a $189 monthly 
premium. His premium is higher 
than Mrs. Anderson's because it is 
based on his current age. Mr. Dodd's 
premium will go up every year. 

• At age 73, his premium goes 
up to $199 

• At age 74, his premium goes 
up to $204 



Note: Look at page 32 if you are thinking about switching Medigap policies to save money. 



23 



Section 3: What You Need to Know About Medigap Policies 



Words in green 
are defined on 
pages 88-91. 



Are there factors other than age that may 
affect the cost of my Medigap policy? 

Yes. The cost of your Medigap policy may be affected 

• By Discounts: Insurance companies may offer discounts to 
females, non-smokers, and/or married people. 

• By Medical Underwriting: Some insurance companies may use 
medical underwriting. This means that you must answer medical 
questions on an application. Fill the application out carefully and 
completely. The insurance company uses this information to 
decide whether to sell you a Medigap policy, how much they will 
charge you, and whether you will have to wait for coverage to 
start. Some companies may add a waiting period for pre-existing 
conditions if your state law allows (see page 29). 

Insurance companies can't use medical underwriting if you are in 
your Medigap open enrollment period (see pages 26-28) or if you 
have special rights (called Medigap protections) to buy a Medigap 
policy (see pages 54—63). 

• If you buy a high-deductible option: Insurance companies may 
offer a "high-deductible option" on Medigap Plans F and J (see 
chart on page 20). If you choose this option, you must pay the 
first $ 1 ,790 (the deductible in 2006) in Medigap-covered costs 
before the Medigap policy pays anything. This amount can change 
each year. 

High-deductible policies often have lower premiums, but if you 
need a lot of Medicare-covered health care services, supplies, and 
equipment, your out-of-pocket costs will be higher, and you may 
not be able to change to another Medigap policy. 

In addition to the $1,790 (in 2006) deductible that you must pay 
for the high-deductible option for Plans F and J, you must also 
pay separate deductibles for 

■ Foreign travel emergency ($250 per year for Medigap 
Plans F and J), and 

■ Prescription drugs ($250 per year for Medigap Plan J 
only, because Medigap Plan F doesn't cover prescription 
drugs). This only applies to Medigap policies bought 
before January 1, 2006. Medigap policies sold after this 
date can't include prescription drug coverage. 



24 



Section 3: What You Need to Know About Medigap Policies 



Are there factors other than age that may affect 
the cost of my Medigap policy? (continued) 

• If you buy a Medicare SELECT policy: Medicare SELECT is a 
type of Medigap policy sold by some insurance companies in some 
states. If you buy a Medicare SELECT policy, you are buying one 
of the 12 standardized Medigap Plans A through L. However, 
Medicare SELECT policies usually require you to use specific 
hospitals and, in some cases, specific doctors to get full insurance 
benefits (except in an emergency). Generally, Medicare SELECT 
policies cost less than other Medigap policies with the same benefits. 

If you have a Medicare SELECT policy and you don't use a 
Medicare SELECT hospital or doctor for non-emergency services, 
your costs will be higher. You will have to pay some or all of what 
Medicare doesn't pay. Medicare will pay its share of approved 
charges no matter which hospital or doctor you choose. 



Words in green 
are defined on 
pages 88-91. 



25 



Section 3: What You Need to Know 



Medigap Policies 



Words in green 
are defined on 
pages 88-91. 



When is the best time to buy a Medigap policy? 

The best time to buy a Medigap policy is during your Medigap open 
enrollment period. 

Your Medigap open enrollment period lasts for six months. It starts on 
the first day of the month in which you are both 

• age 65 or older, and 

• enrolled in Medicare Part B. 

Once your six-month Medigap open enrollment period starts, it can't 
be changed. 

During this period, an insurance company can't 

• deny you any Medigap policy it sells, 

• make you wait for coverage to start, or 

• charge you more for a Medigap policy because of your health problems. 

While the insurance company can't make you wait for all your coverage to 
start, it may be able to make you wait for coverage of a pre-existing 
condition (see page 29). However, if you buy the Medigap policy during 
your Medigap open enrollment period, and if you recently had certain 
kinds of health coverage, called "creditable coverage," (see pages 30-31) the 
insurance company must shorten the waiting period, or eliminate it entirely. 

If you are eligible for Medicare because you're disabled or have 
End-Stage Renal Disease (ESRD), see pages 65-68. 

Note: You can send in your application for a Medigap policy before your 
Medigap open enrollment period starts. This may be important if you 
currently have coverage that will end when you turn age 65. This will allow 
you to have continuous coverage, without any break. 

How can I tell if I'm in my Medigap open 
enrollment period? 

You can tell if you are in your Medigap open enrollment period by looking 
at your red, white, and blue Medicare card (see sample card on the next 
page) . The lower right corner of this card shows the dates that your 
Medicare Part A and Part B coverage started. If you are age 65 or older, 
add six months to the date that your Medicare Part B coverage starts. 
If that date is in the future, you are still in your Medigap open enrollment 
period. If that date is in the past, your Medigap open enrollment period is 
over (see example on the next page). 



26 



Section 3: What You Need to Know About Medigap Policies 




1 -800-MEDICARE (1-800-633-4227) 

NAME OF BENEFICIARY 

JANE DOE 



MEDICARE CLAIM NUMBER 

000-00-QOOO-A 

IS ENTITLED TO 

HOSPITAL 
MEDICAL 






SIGN 
HERE 



SEX 

FEMALE 

EFFECTIVE DATE 

(PART A) 07-01-1986 
(PARTB) 07-01-1986 



\guzl Z* K= \ )cr?^y 



Note: There are earlier 
versions of this card that 
are slightly different. They 
are still valid. 



Example: Medigap Open Enrollment Period 



It is October 1, 2006, and Mr. Rodriguez (age 65) wants to buy 
a Medigap policy. He needs to know if he is in his Medigap 
open enrollment period. He looks at his Medicare card. His 
Medicare Part B coverage started August 1, 2006. To figure out if 
he is in his Medigap open enrollment period, he must add six 
months to his Medicare Part B start date and see if it is before or 
after the current date. 

August 1, 2006 + six months = February 1, 2007 

Since it is October 1 , 2006, he is still in his Medigap open 
enrollment period. Mr. Rodriguez has until January 3 1 , 2007, to 
buy a Medigap policy during his Medigap open enrollment period. 



What if my Medigap open enrollment period 
is over? 

If you apply for a Medigap policy after your Medigap open 
enrollment period has ended, the Medigap insurance company is 
allowed to use medical underwriting (see page 24) to decide whether 
to accept your application, and how much to charge you for the 
Medigap policy. If you are in good health, the insurance company is 
likely to sell you the Medigap policy, but there is no guarantee that 
they will (unless you become eligible for one of the Medigap 
protections listed on page 55). However, not all insurance companies 
actually use medical underwriting, so be sure to ask. 



27 



I am over age 65 and still working (or 
covered under my working spouse's health 
plan). Should I enroll in Medicare Part B and 
start my Medigap open enrollment period? 

If you or your spouse is working and have group health coverage 
through an employer or union, your Medigap open enrollment 
period won't start until you sign up for Medicare Part B. For this 
reason, you may want to wait to enroll in Medicare Part B. 
Remember, once you're age 65 or older and enrolled in Medicare 
Part B, your Medigap open enrollment period starts and can't be 
changed. 

However, if your employer group health plan only pays after 
Medicare pays (see page 57), your plan may require you to enroll in 
Medicare Part B to get benefits under the employer plan. 

Important information about enrolling in 
Medicare Part B 

If you don't enroll in Medicare Part B when you are first eligible or 
after you drop employer coverage, you may have to pay a higher 
monthly premium for Medicare Part B. You will have to pay this 
extra amount as long as you have Medicare Part B. 

There are three times when you can enroll in Medicare Part B. 
These are called your: 

1 . Initial Enrollment Period — Starts three months before the 
month you turn age 65 and ends three months after the month 
you turn age 65. 

2. General Enrollment Period — This period runs from January 1 
through March 3 1 of each year. Your coverage will start on 
July 1 of the year you sign up. 

3. Special Enrollment Period — A time when you may enroll, if you 
meet certain conditions (for example, your group health plan 
coverage ends). 

It's very important to learn about these enrollment periods. 

For more information about these enrollment periods, get a free copy 
of "Enrolling in Medicare" (CMS Pub. No. 1 1036) at 
www.medicare.gov on the web. Select "Search Tools" at the top of 
the page. Or, call 1-800-MEDICARE (1-800-633-4227). TTY users 
should call 1-877-486-2048. 



28 



Section 3: What You Need to Know About Medigap Policies 



Pre-existing conditions 

What is a pre-existing condition? 

A pre-existing condition is a health problem you have before the 
date a new insurance policy starts. 



Words in green 
are defined on 
pages 88-91. 



Will my pre-existing condition be covered if 
I buy a Medigap policy? 

It depends. In some cases, if you have a health problem before your 
Medigap policy starts, a Medigap insurance company can refuse to 
cover that health problem for up to six months. This is called a 
"pre-existing condition waiting period." The insurance company can 
only use this kind of waiting period if your health problem was 
diagnosed or treated during the six months before the Medigap 
policy starts. This means that the insurance company can't make you 
wait for coverage of your condition just because it thinks you should 
have known to see a doctor. 

• During your Medigap open enrollment period 

If you buy a Medigap policy during your Medigap open 
enrollment period, and you had at least six months of previous 
health coverage that qualifies as "creditable coverage" (see page 30), 
the company can't apply a pre-existing condition waiting period. 
If you had less than six months of creditable coverage, this waiting 
period will be reduced by the number of months of creditable 
coverage you had. 

• When you have special Medigap protections (Guaranteed 
Issue Rights) 

If you buy a Medigap policy when you have special Medigap 
protections (also called guaranteed issue rights), the insurance 
company can't use a pre-existing condition waiting period. For 
more information about Medigap protections, see pages 54-63. 

If you want to know if you will have a pre-existing condition 
waiting period if you switch Medigap policies, see page 32. 



29 



Section 3: What You Need to Know About Medigap Policie 



Creditable coverage 

What is creditable coverage? 

Creditable coverage (for Medigap policies) is generally any other health 
coverage you recently had before applying for a Medigap policy. 

These types of health care coverage may count as creditable coverage 
for Medigap policies: 

A group health plan (like an employer or union plan) 

A health insurance policy 

Medicare Part A or Medicare Part B 

Medicaid (see pages 74-75) 

A medical program of the Indian Health Service or tribal 
organization 

A state health benefits risk pool (sometimes called a state high 
risk pool) 

TRICARE (the health care program for military dependents and 
retirees, see page 76) 

A Federal Employees Health Benefit plan 

A public health plan 

A health plan under the Peace Corps Act 

COBRA (Consolidated Omnibus Budget Reconciliation Act, see 
pages 71-72) 

SCHIP (State Children's Health Insurance Program, see page 77) 

Important: Whether you had creditable coverage depends on 
whether you had any "breaks in coverage" — when you were without 
any of these kinds of health coverage for more than 63 days in a row. 
You can only count creditable coverage that you had after that break 
in coverage. If you have had one or more breaks in coverage, but 
each break was shorter than 63 days, then you can add the periods of 
coverage together. This will count towards your creditable coverage. 

The following doesn't count as creditable coverage: 

• Hospital indemnity insurance 

• Specified disease insurance (like cancer insurance) 

• Vision or dental policies 

• Long-term care policies 



30 



Section 3: What You Need to Know About Medigap Policies 



What is creditable coverage? (continued) 



Example: Creditable Coverage 



Mr. Smith is 65 and is being treated for heart disease. His Medicare 
Part A and Part B started November 1, 2005. Before this date, he 
had no health insurance coverage. 

On March 1 , 2006, after four months with Medicare and still within 
his Medigap open enrollment period, Mr. Smith buys a Medigap 
policy. His Medigap insurance company would normally refuse to 
cover his heart disease condition for six months (the pre-existing 
condition waiting period). However, since Mr. Smith had Medicare 
Part A and Part B from November 1 to March 1 , the insurance 
company must use his four months of Medicare coverage as 
creditable coverage to shorten this six-month waiting period. 

Now his waiting period will only be two months instead of six 
months. During these two months, after Medicare pays its share, 
Mr. Smith will have to pay the rest of the costs for the care of his 
heart disease. He will also have to pay his Medigap premiums. 
The Medigap policy will pay for other covered care, and, after two 
months, will begin to cover the out-of-pocket costs related to his 
heart disease. 



31 



Section 3: What You Need to Know About Medigap P« 



Switching Medigap policies 

What if I have a Medigap policy and I want to 
switch to a different Medigap policy? 

You may not have a guaranteed right to switch Medigap policies. But, if 
you are given the opportunity, make sure you compare benefits and 
premiums before switching Medigap policies. If you bought your 
Medigap policy before 1992, it may offer better coverage than a newer 
Medigap policy. On the other hand, older Medigap policies may have 
bigger premium increases than newer standardized Medigap policies 
currently being sold. 



Words in green 
are defined on 
pages 88-91. 



If you decide to switch, don't cancel your first Medigap policy until you 
have decided to keep the second Medigap policy. You have 30 days to 
decide if you want to keep the new Medigap policy. This is called your 
"free look" period. The 30-day free look period starts when your 
Medigap policy is issued to you. After your 30-day free look period, if 
you decide to keep your second Medigap policy, you should cancel your 
first Medigap policy. You promised on the application for the new 
Medigap policy that you would cancel your first Medigap policy. Also, 
paying a second Medigap premium would be a waste of money. 

Do I have to switch Medigap policies if I have 
an older Medigap policy? 

No. If you have an older Medigap policy that you bought before 1992, 
you can generally keep it. You don't have to switch to one of the 
standardized Medigap policies. But, if you decide to buy a newer Medigap 
policy, you won't be able to go back to your old Medigap policy. 

Do I have to wait a certain length of time before 
I can switch to a different Medigap policy? 

No, but your new Medigap policy might not cover all your pre-existing 
conditions if you've had your current Medigap policy for less than six 
months. However, the amount of time you've had your current Medigap 
policy must count towards the amount of time you must wait before 
your new Medigap policy covers your pre-existing condition. 

If the new Medigap policy has a benefit that wasn't in your old Medigap 
policy, the company may be able to make you wait up to six months 
before covering you for that benefit, regardless of how long you have 
had your current Medigap policy. 



32 



Section 3: What 



eed to Know About Medigap Policie 



Words in green 
are defined on 
pages 88-91. 



Losing Medigap coverage 

Can my Medigap insurance company 
drop me? 

In most cases, no. If you bought your Medigap policy after 1990, 
the Medigap policy is required to be guaranteed renewable. This 
means your insurance company can drop you only if 

• you stop paying your premium, 

• you aren't truthful about something under the Medigap policy, or 

• the insurance company goes bankrupt. 

Insurance companies in some states may be able to drop you if you 
bought your Medigap policy before 1990. For an insurance 
company to refuse to renew one of these older Medigap policies, 
the company must get the state's approval. If this happens, you have 
the right to buy another Medigap policy (see Medigap Protections, 
Situation #6 on page 61). 



33 



eaion 



.now 



ugap roncies 



Words in green 
are defined on 
pages 88-91. 



How your bills get paid 

Does the Medigap insurance company pay my 
doctor directly? 

Yes, most Medigap insurance companies provide this service. Here is 
how this works: 

All of your doctors must submit your claims directly to Medicare for 
you. Medicare then decides what it owes, and sends you a notice 
(called a "Medicare Summary Notice"). 

Under most Medigap policies, by signing the Medigap insurance 
contract you agree to have the Medigap insurance company get the 
claim information directly from Medicare and then pay the doctor 
directly. 

If your Medigap insurance company doesn't provide this service, ask 
your doctors if they "participate" in Medicare. (This means that they 
accept "assignment" for all their Medicare patients,) If your doctor 
does participate, the Medigap insurance company is required to pay 
the doctor directly. Make sure to ask the doctor's staff to put on the 
Medicare claim form that you have a Medigap policy and want 
Medigap insurance benefits paid directly to the doctor. Make sure that 
the doctor's records show your Medigap insurance company name and 
your Medigap policy number correctly. You will need to sign the claim 
form, or have your doctor keep your signature on record. 

If your doctor doesn't participate, and your Medigap insurance 
company doesn't have an agreement with Medicare, when you get your 
"Medicare Summary Notice" explaining what Medicare has paid on 
your claim, you will need to submit the claim directly to the Medigap 
insurance company. However, this is unusual. 

If you have any questions about Medigap claim filing, you can call 
1-800-MEDICARE (1-800-633-4227). TTY users should call 
1-877-486-2048. 



34 



.now adoui ivieaigap roucies 



Watch out for illegal insurance 
practices 

It is illegal for anyone to 

• pressure you into buying a Medigap policy, or lie or mislead you to 
switch from one company or policy to another. 

• sell you a second Medigap policy when they know that you already 
have one, unless you tell the insurance company in writing that 
you plan to cancel your existing Medigap policy. 

• sell you a Medigap policy if they know you have Medicaid, except 
in certain situations (see page 75). 

• sell you a Medigap policy if they know you are in a Medicare 
Advantage Plan (unless your enrollment is ending from a Medicare 
Advantage Plan). 

• claim that a Medigap policy is part of the Medicare Program or 
any other Federal program. Remember, Medigap is private 
health insurance. 

• sell you a Medigap policy that can't legally be sold in your state. 
Check with your State Insurance Department (see pages 85-86) to 
make sure that the Medigap policy you are interested in can be 
sold in your state. 

• misuse the names, letters, or symbols of the U.S. Department of 
Health & Human Services (HHS), Social Security Administration 
(SSA), Centers for Medicare & Medicaid Services (CMS), or any 
of their various programs like Medicare. (For example, suggesting 
the Medigap policy has been approved or recommended by the 
Federal government.) 

• claim to be a Medicare representative, if they work for a Medigap 
insurance company. 

If you believe that a Federal law has been broken, call the Inspector 
General's hotline at 1-800-HHS-TIPS (1-800-447-8477). In most 
cases, however, your State Insurance Department can help you with 
insurance-related problems (see pages 85-86). 



35 



ecu on 



.now 



ugap policies 



Words in green 
are defined on 
pages 88-91. 



Ways to check if an insurance 
company is reliable 

To help you find out if an insurance company is reliable, you can take 
the following actions: 

• Call the State Insurance Department in your state (see pages 85—86). 
Ask if they keep a record of complaints against insurance companies 
and ask whether these can be shared with you. 

• Call the State Health Insurance Assistance Program in your state (see 
pages 85-86). These programs can give you free help with choosing a 
Medigap policy. 

• Go to your local public library. Your local public library can 
help you 

■ get information on an insurance company's financial 
strength by independent rating services such as 

Weiss Rating, Inc., A.M. Best, and Standard & Poor's, and 

■ look at information on the web. 

• Talk to someone you trust, like a family member, your insurance 
agent, or a friend who has a Medigap policy from the same Medigap 
insurance company. 



36 





■'"'■ 



Section 4 



Prescription Drug 
Coverage Overview 



37 



Words in green 
are defined on 
pages 88-91. 



Section 4: Prescription Drug Coverage Overview 



If you have a Medigap policy with prescription drug coverage, you 
should read this section carefully. 

Medicare Prescription Drug Coverage 

As of January 1, 2006, Medicare offers prescription drug coverage for 
all people with Medicare. Insurance companies and other private 
companies are working with Medicare to offer Medicare drug plans. 

The new Medicare drug plans might be a good choice for you. There 
are two types of plans that provide insurance coverage for prescription 
drugs. There is prescription drug coverage that is part of Medicare 
Advantage Plans and other Medicare Health Plans. There is also 
Medicare prescription drug coverage that adds coverage to the 
Original Medicare Plan, some Medicare Cost Plans, and Medicare 
Private Fee-for-Service Plans. For information about Medicare drug 
plans, you can 

• look in the "Medicare & You" handbook (CMS Pub. No. 10050). 
This handbook is mailed to people with Medicare every fall. 

• visit www.medicare.gov on the web. You can get personalized 
Medicare drug plan information for your area from this website. 

• call 1-800-MEDICARE (1-800-633-4227). A customer service 
representative can answer your Medicare questions and help 
compare Medicare drug plans. TTY users should call 
1-877-486-2048. 

• call your State Health Insurance Assistance Program (SHIP) (see 
pages 85-86). Your SHIP can provide one-on-one help comparing 
your health insurance options. 



Medigap Policies and Medicare Prescription 
Drug Coverage 

Because of Medicare prescription drug coverage, the rules about 
prescription drug coverage under Medigap policies have changed. 

Note: If your prescription drug coverage is through a Medigap policy, 
see "Medigap Policies and Medicare Prescription Drug Coverage" 

on pages 39-40 and Situation #8 on page 62. 



38 



Section 4: Prescription Drug Coverage Overview 



Medigap Policies and Medicare Prescription Drug 
Coverage (continued) 

I have a Medigap policy with prescription drug coverage. 
How does the new Medicare prescription drug coverage 
affect my Medigap policy? 

If your Medigap policy covers prescription drugs, you should have 
received detailed information from your Medigap insurance company that 
described how the new Medicare prescription drug coverage affects your 
Medigap policy. The notice tells you how your Medigap policy's 
prescription drug coverage compares to Medicare prescription drug 
coverage. You need to decide whether a Medicare Prescription Drug Plan 
may meet your needs better than the prescription drug coverage in your 
Medigap policy. If you can't find your copy, ask your Medigap insurance 
company for another one. Read it carefully before making any decisions. 



If your Notice said Then 


Your Medigap policy's 
prescription drug coverage won't 
pay out as much as Medicare 
prescription drug coverage. 


If you wait until after May 15, 2006, and then decide to 
enroll in a Medicare Prescription Drug Plan, you will likely 
have to pay a penalty (higher premium), and you will lose 
the right to switch to another Medigap policy (without 
prescription drugs) sold by the same Medigap insurance 
company. Even if the prescription drug coverage under 
your Medigap policy currently meets your needs, you 
should compare costs with Medicare Prescription Drug 
Plans and think about your future needs. 


Your Medigap policy's 
prescription drug coverage will 
pay out as much as Medicare 
prescription drug coverage. 


You will probably not pay a penalty if you keep your 
current Medigap policy with the prescription drug benefits, 
and you later decide to join a Medicare Prescription 
Drug Plan. However, you should compare costs under 
the two types of plans and decide which one will better 
meet your needs. Also, if you would like a guaranteed 
right to switch to another Medigap policy without 
prescription drugs, that is offered by the same Medigap 
insurance company, you must enroll in a Medicare 
Prescription Drug Plan no later than May 15, 2006. 



If you have questions about the notice you received, call your Medigap insurance company or 
your State Health Insurance Assistance Program (see pages 85—86). 

Important: If you join a Medicare Prescription Drug Plan, you can't have prescription drug 
coverage in your Medigap policy. 



39 



4: Prescription Drug C 



Medigap Policies and Medicare Prescription Drug 
Coverage (continued) 

How does my Medigap prescription drug coverage compare 
to a Medicare Prescription Drug Plan? 

On average, most Medigap prescription drug coverage doesn't pay out as 
much as a Medicare Prescription Drug Plan. That means that if you wait 
until after May 15, 2006, and later decide to enroll in a Medicare 
Prescription Drug Plan, you may have to pay a penalty. This late 
penalty means your Medicare Prescription Drug Plan premium cost 
will go up at least 1 % per month for every month that you wait to 
join. You will have to pay this extra amount for as long as you have 
Medicare prescription drug coverage. Also, if you sign up after May 15, 
2006 you won't be guaranteed a right to switch to another Medigap 
policy that has no prescription drug coverage. 

A Medigap policy with prescription drug coverage bought before mid- 
1992 may pay out as much as or more than a Medicare Prescription 
Drug Plan. Medigap policies sold in Massachusetts, Minnesota, and 
Wisconsin with prescription coverage may also pay out as much as or 
more than a Medicare Prescription Drug Plan. 

If your Medigap policy is one of a few that are found, on average, to pay 
out at least as much as standard Medicare prescription drug coverage, 
you can wait until after May 15, 2006 to enroll in a Medicare 
Prescription Drug Plan and not have to pay a penalty. However, you 
must join the Medicare Prescription Drug Plan within 63 days of your * 
current coverage ending. Otherwise, you will have to pay a penalty. Also, 
you may have to wait until the end of any year before you have another 
chance to enroll, and that may mean you will have to wait longer than 
63 days. 

Even if you would not have to pay a penalty, you should carefully compare 
premiums and any other out-of-pocket costs under your Medigap 
prescription drug coverage with costs under a Medicare Prescription 
Drug Plan, and determine which one will better meet your needs. 

Note: Every year before November 15, your Medigap insurance 
company must send you a notice that tells you how your Medigap 
policy's prescription drug coverage compares to a Medicare Prescription 
Drug Plan. 

If you have questions, you can call your Medigap insurance company or 
your State Health Insurance Assistance Program (see pages 85-86). 



40 




Section 5 



Steps to Buying a 
Medigap Policy 



41 



■ecuon 




Words in green 
are defined on 
pages 88-91. 



Steps to buying a Medigap policy 

Buying a Medigap policy is an important decision. Only you can decide 
if a Medigap policy is the right kind of health insurance coverage for 
you to supplement Medicare coverage. If you decide to buy a Medigap 
policy, shop carefully. Look for a Medigap policy that you can afford 
and that gives you the coverage you need most. As you shop for a 
Medigap policy, keep in mind that different insurance companies may 
charge different amounts for exactly the same Medigap policy, and not 
all insurance companies offer all of the Medigap policies. 

The steps to buying a Medigap policy include the following: 

STEP 1 : Decide which benefits you want, then decide which of the 
Medigap Plans A through L meet your needs (see below and 
pages 43-48). 

STEP 2: Find out which insurance companies sell Medigap policies in 
your state (see page 49). 

STEP 3: Call the insurance companies that sell the Medigap policies 
that you are interested in and compare costs (see page 50). 

STEP 4: Choose the right Medigap policy for you (see page 51). 

STEP 5: Buy the Medigap policy (see page 52). 



STEP 1. Decide which benefits you want, then 
decide which of the Medigap Plans A 
through L meet your needs. 



The charts on the following pages will help you compare the different 
types of benefits that each Medigap policy offers. The charts on pages 
43—45 will help you compare the basic benefits. See pages 46—48 to 
compare the extra benefits. 

Important: You should think about your current and future health care 
needs because you might not be able to switch Medigap policies later. 
Remember that Medigap policies no longer offer prescription drug 
coverage. You may want to enroll in a Medicare Prescription Drug Plan 
in addition to buying a Medigap policy. For more information about 
Medicare prescription drug coverage, see pages 38-40. 



42 



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vo 






You pay. . . 

• Nothing for the first 
20 days. 

• Up to $29.75 per day for 
days 21-100. 

• All costs after day 100. 


You pay $238 for days 1-60 
of a hospital stay. 


o a 

O (0 
fM u\ 


you pay in 
have Medi 


1 ■ 
■ 
■ 


What . 
if you 
Plan L 


(0 


You pay... 

• Nothing for the first 
20 days. 

• Up to $59.50 per day for 
days 21-100. 

• All costs after day 100. 


You pay $476 for days 1 -60 
of a hospital stay. 


o a 

o re 
in m 


you pay in 
have Medi 


■ 


hat j 
you 
an K 


3£S 


You pay... 

• Nothing for the first 
20 days. 

• Up to $1 19 per day for 
days 21-100. 

• All costs after day 100. 


For each benefit period you 
pay a total of $952 
for a hospital stay of 
1—60 days. 


c > ^ 


ITr g *Wr i - tHqImJ 


>^=^ 


t you pa 
u don't 
igap Po 


Wha 
if yo 
Med 


.8 


i0 

o 


Medicare pays all 
covered costs for the 
first 20 days of SNF 
care. For days 
21-100, Medicare 
pays all covered 
costs except for up 
to $ 1 1 9 per day. 


Medicare pays all 
but a total of $952 
for a hospital stay 
of 1—60 days. 


•c o 

Q) CM 


St 






Skilled Nursing 
Facility (SNF) 
Care 

Coinsurance 
(Skilled nursing 
and rehabilitative 
services in a 
skilled nursing 
facility after a 


related three-day 
hospital stay) 
(See benefit 
period on page 
88.) 


Medicare 
Part A 
Deductible 


Extra 
Bene 



STEP 2. Find out which insurance companies 
sell Medigap policies in your state. 





To find out which insurance companies sell Medigap policies in your 
state, you can do any of the following: 

• Call your State Health Insurance Assistance Program (see pages 
85-86). Ask if they have a "Medigap rate comparison shopping 
guide" for your state. This type of guide usually lists the insurance 
companies that sell Medigap policies in your state and their costs. 

• Call your State Insurance Department (see pages 85-86). 

• Visit www.medicare.gov on the web. Select "Search Tools" at the 
top of the page, then select "Compare Health Plan Options in 
Your Area." 

This website will help you find information on all your health 
plan options, including the Medigap policies in your area. You can 
also get information on the following: 

j Insurance companies that sell Medigap policies in your 
state, 

j How to contact these insurance companies, 

/ What the Medigap policies must cover, and 

/ How insurance companies decide what to charge you 
for a Medigap policy premium. 

If you don't have a computer, your local library or senior center 
may be able to help you look at this information. 

• Call 1-800-MEDICARE (1-800-633-4227). A customer service 
representative will help you get information on all your health plan 
options, including the Medigap policies in your area. You will get 
your results in the mail within three weeks. TTY users should call 
1-877-486-2048. 

You should plan to call more than one insurance company that sells 
Medigap policies in your state since costs can vary between 
companies. Check the companies you call to be sure they are honest 
and reliable (see page 36). 



49 



5: Steps t< 



lap Policy 






u 




STEP 3. Call the insurance companies that sell 
the Medigap policies that you are 
interested in and compare costs. 



Call more than one insurance company and ask the questions listed 
below. Friends and relatives can tell you about their Medigap policies and 
the quality of service, but their Medigap policies might not fit your needs. 

Medigap Policy Comparison Worksheet 

Use this worksheet to compare costs and benefits you are considering. Make sure you get 
the names, addresses, and telephone numbers of the insurance companies and the agents 
you talk to. 



50 



Ask each insurance company... 


Company 1 


Company 2 


Are you licensed in this state? (The answer should be yes.) 




— ■ 


Do you sell Medigap Plan (say the Medigap plan you're interested 
in, for example, Medigap Plan F)? Note: Insurance companies 
usually offer some, but not all, of the Medigap plans. Make sure 
they sell the Medigap plan you want. 






What is the cost of this Medigap policy? 






What has the cost of this Medigap policy been for the past 
few years? 






How is the price decided? 

• What type of pricing does this insurance company use? 
(Community-rated, issue-age-rated, or attained-age-rated, 
see pages 22—23) 

• Is there a discount if I am a female, a non-smoker, 
or married? 




- 


Are there any additional ("innovative") benefits or discounts 
included in this Medigap policy? 






If you aren't in your Medigap open enrollment period or in 
another situation where you have a guaranteed issue right, ask: 

• Will you accept my application? 

• Do you review my health records or application (medical 
underwriting) to decide how much to charge me for a 
Medigap policy? 

• If you have a pre-existing condition ask, "Will my 
pre-existing condition mean a delay in the start of 
my benefits?" 










a Medigap Policy 



STEP 4. Choose the right Medigap policy for you. 




After you call the insurance companies, compare their costs and check to 
see if the companies are reliable. Then choose the Medigap policy that is 
right for you. 

To make your final choice, you should do the following: 

• Carefully review the Medigap policy to make sure it covers the benefits 
you need and want. 

• Decide if you can afford the cost of the Medigap policy. 

• Make sure you feel good about and trust the insurance company 
and/or the insurance agent. 

• If possible, talk with someone you trust, like a family member, friend, 
doctor, insurance agent, or your State Health Insurance Assistance 
Program (see pages 85-86) about your choice. 

Once you have done the items above, you are ready to move on to 
Step 5 (see page 52). 



51 



ecxion 



STEP 5. Buy the Medigap policy. 




Once you decide on the insurance company and the Medigap 

policy you want, you can apply for your Medigap policy. 

The insurance company must give you a clearly worded summary 

of your Medigap policy when you apply. Read it carefully. 

If you don't understand it, ask questions. Remember the 

following when you buy your Medigap policy: 

• Fill out your application carefully and completely. If the 
insurance agent fdls out the application, review it to make sure 
it's correct. Otherwise, answer all of the medical questions 
carefully. If you buy your Medigap policy during your Medigap 
open enrollment or guaranteed issue period, the insurance 
company can't use any medical answers you give them to deny 
you coverage or price the Medigap policy. 

• It is best to pay for your Medigap policy by check, money 
order, or bank draft. Make it payable to the insurance company, 
not the agent. Get a receipt with the insurance company's 
name, address, and telephone number for your records. 

• Ask for your Medigap policy to become effective when you 
want coverage to start, or when your old Medigap policy 
coverage ends. If, for any reason, the insurance company won't 
give you the start date you want, call your State Insurance 
Department (see pages 85-86). 

• Your insurance company is required to send you a copy of your 
Medigap policy within 30 days after you purchase the Medigap 
policy. If you don't get your Medigap policy in 30 days, call 
your insurance company. If you don't get your Medigap policy 
in 60 days, call your State Insurance Department (see pages 
85-86). 

Remember, you don't need more than one Medigap policy. If you 
already have a Medigap policy, it is illegal for an insurance 
company to sell you a second policy unless you tell them in 
writing that you will cancel the first Medigap policy. However, 
don't cancel your old Medigap policy until the new one is in 
place, and you decide to keep it. Once you receive the new 
Medigap policy, you have 30 days to decide if you want to keep 
the new Medigap policy. This is called your "free look" period. 
The 30 -day free look period starts when your Medigap policy is 
issued to you. 



52 




Section 6 



Medigap Rights 
and Protections 



53 



ecuon 



EJEajEiaJESHS 



If you live in 
Massachusetts, 
Minnesota, or 
Wisconsin, you 

have the same 
guaranteed issue 
rights to buy a 
Medigap policy, 
but the policies 
are different. 
If you have 
questions, call 
your State 
Insurance 
Department 
(see pages 
85-86). 



Words in green 
are defined on 
pages 88-91. 



Medigap rights and protections 
(guaranteed issue rights) 

Your rights to buy a Medigap policy 

In some situations, you have the right to buy a Medigap policy outside 
of your Medigap open enrollment period. These rights are called 
"Medigap protections." They are also called guaranteed issue rights 
because the law says that insurance companies must sell ("issue") you a 
Medigap policy even if you have health problems. 

In these situations, an insurance company 

• must sell you a Medigap policy, 

• must cover all your pre-existing conditions (see page 29), and 

• can't charge you more for a Medigap policy because of past or present 
health problems. 

In many cases, you get these protections when you. have other health 
coverage that changes in some way. 

Note: If you drop your Medigap policy, you may not be able to get it 
back except in very limited cases. 

Important: In some situations, you have a guaranteed issue right to buy 
a Medigap policy if you lose certain kinds of health coverage. You should 
keep a copy of any letters, notices, and claim denials that show you have 
lost your other coverage. Be sure to keep anything that has your name on 
it. Also, keep the postmarked envelope these papers come in as proof of 
when it was mailed. You may need to send a copy of some or all of these 
papers with your application for a Medigap policy to prove you lost 
coverage and have the right to these Medigap protections. 

Remember, it is best to apply for a Medigap policy before your current 
health coverage has ended. You can apply for a Medigap policy while you 
are still in your health plan and choose to start your Medigap coverage 
the day after your health plan coverage ends. This will prevent breaks in 
your health coverage. 

The Medigap protections in this section are from Federal law. Many 
states provide additional Medigap protections. For example, your state 
might give you a longer time to apply for a Medigap policy when you lose 
your coverage. Call your State Health Insurance Assistance Program or 
State Insurance Department for more information (see pages 85-86). 



54 



Medigap protections if you lose or drop your health 
care coverage (guaranteed issue rights) 

To get these Medigap protections, you must meet one of the conditions listed below. 
These rights are for both Medigap and Medicare SELECT policies. 

Important: There may be times when more than one situation applies to you. When 
this happens, you can choose the Medigap protection that gives you the best choice 
of Medigap policies. 

Note: Programs of All-inclusive Care for the Elderly (PACE) is available only in 
states that choose to offer it under Medicaid. If you have Medicaid, an insurance 
company can sell you a Medigap policy only in certain situations (see page 75). 



Situation Protects you if... See 

page 


1 


You are in a Medicare Health Plan rather than the 
Original Medicare Plan and the plan is going to leave the 
Medicare Program or stop giving care in your area. 


56 


2 


You have employer group health plan or union coverage 
that is ending. 


57 


3 


Your coverage ends because you move out of the plan's 
service area. 


58 


4 


You joined a Medicare Advantage Plan or PACE when 
you were first eligible for Medicare at age 65 and within 
the first year of joining, you decide you want to switch 
to the Original Medicare Plan. 


59 


5 


You dropped a Medigap policy to join a Medicare Advantage 
Plan or other Medicare Health Plan (or to switch to a 
Medicare -SELECT policy) for the first time; you have been 
in the plan less than a year; and you want to switch back. 


60 


6 


Your Medigap insurance company goes bankrupt and 
you lose your coverage, or your Medigap policy coverage 
otherwise ends through no fault of your own. 


61 


7 


You leave a Medicare Advantage Plan, or drop a Medigap 
policy, because the company hasn't followed the rules or 
it misled you. 


61 


8 


You have a Medigap policy that covers prescription drugs. 
You want to enroll in the new Medicare prescription drug 
coverage and switch to another Medigap policy that 
doesn't have prescription drug coverage. 


62 



55 



6: Medigap Rights and Protections 



Medigap protections 



SITUATION #1: You are in a Medicare Health Plan rather than 
the Original Medicare Plan and the plan is going to leave the 
Medicare Program or stop giving care in your area. 



In this situation, your Medicare Health Plan sends you a letter 
telling you when your coverage is ending. The letter tells you if there 
are any other Medicare Health Plans in your area. If you switch to 
one of those you won't need a Medigap policy. 

However, if you decide to switch to the Original Medicare Plan 
you have a right to buy a Medigap Plan A, B, C, or F (your state 
might give you more choices) that is sold in your state by any 
insurance company. 

You have two choices of when to get your Medigap policy: 

1 . Leave (disenroll from) your Medicare Health Plan any time 
after the day you get your letter, but before your coverage 
would otherwise end. You will automatically return to Original 
Medicare. You will have 63 calendar days from the day you 
leave your Medicare Health Plan to apply for a Medigap policy. 

2. Stay in your Medicare Health Plan until the date your coverage 
ends. You will automatically return to the Original Medicare 
Plan when your coverage ends. You will have 63 calendar days 
after your coverage ends to apply for a Medigap policy. 

Important: You will have additional rights under Situation #4 (see 
page 59) or Situation #5 (see page 60) if you meet the conditions 
described in those situations. If, instead, you immediately join 
another Medicare Advantage Plan, you can stay in that plan for up to 
one year and still have the rights described in Situations #4 and #5. 



56 



Section 6: Medigap Rights and Protections 



Medigap protections (continued) 



SITUATION #2: You have an employer group health plan or 
union coverage that is ending. 



In this situation, you are in the Original Medicare Plan and you also 
have coverage from an employer group health plan or union, including 
COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage. 
If your coverage is retiree coverage or COBRA coverage, Medicare 
probably pays first, and your plan pays second. Here are your rights 
under Federal law if you are in a plan that pays second, and you lose 
coverage for one of the following reasons: 

• the employer goes out of business, 

• the employer stops offering the health plan, 

• you are no longer eligible for the health plan (for example, if the 
coverage is from your spouse, and you get divorced or your 
spouse dies), or 

• you have COBRA coverage that is ending. 

In this situation, you have the right to buy a Medigap Plan A, B, C, or 
F (your state might give you more choices) that is sold in your state by 
any insurance company. You must apply for the Medigap policy within 
63 calendar days after the latest of these three dates: 

• the date the coverage ends, 

• the date on your notice that coverage is ending (if you receive one), or 

• the date on your claim denial, if this is the only way you know that 
your coverage has ended. 

Keep the notice or claim denial that has your name on it. This will 
help prove that you lost coverage. 

Important: If the employer offers you "COBRA" coverage (see pages 
71-72) you can either buy a Medigap policy right away or you can 
wait until the COBRA coverage ends and then you will have another 
right to buy a Medigap policy. 

Note: If your coverage is from your (or your spouse's) current 
employment, the plan probably pays first, and Medicare pays second. 
In this situation, state laws may vary. If you lose coverage under an 
employer group health plan that pays before Medicare, state law might 
give you a right to buy a Medigap policy. For more information, call 
your State Health Insurance Assistance Program (see page 85-86). 



57 



Section 6: Medigap Rights and Protections 



Medigap protections (continued) 



Words in green 
are defined on 
pages 88-91. 



SITUATION #3: Your coverage ends because you move out of 
the plan's service area. 



If you have health coverage from a Medicare Advantage Plan or you 
are in PACE, and you move out of the plans service area, you will 
have to end your coverage. 

If you have a Medicare SELECT policy, you can keep your policy 
because it is guaranteed renewable. However, because you have 
moved, you may not be able to use hospitals or other health care 
providers that are on the policy's list of approved providers. This is 
called the policy's "network." Therefore, you might want to switch to 
another Medigap policy. 

You have the right to buy a Medigap Plan A, B, C, or F (your state 
might give you more choices) that is sold by any insurance company 
in your state (if you move within the same state but outside of the 
plan's service area), or the state you are moving to. (if you move out 
of state). 

You must tell your current plan that you are moving and give them a 
date when you will end your coverage. You can apply for a Medigap 
policy as early as 60 calendar days before the date your health 
coverage ends. You must apply for a Medigap policy no later than 63 
calendar days after your health coverage ends to get this protection. 

Important: If you have PACE, see the note on page 55. 



58 



Section 6: Medigap Rights and Protecti 



Medigap protections (continued) 



SITUATION #4: You joined a Medicare Advantage Plan or 
PACE when you were first eligible for Medicare at age 65 and 
within the first year of joining, you decide you want to switch 
to the Original Medicare Plan. 



You have the right to buy any Medigap policy that is sold in your 
state by any insurance company. You must tell the health plan that 
you want to leave (disenroll) and give them a date to end your 
coverage. This date must be before you have been in the plan for a 
year. You will have from 60 calendar days before your coverage ends 
until 63 calendar days after your coverage ends to apply for a new 
Medigap policy. 

Your rights under this situation may last for an extra 12 months if 
the plan you first joined leaves the Medicare Program or stops 
giving care in your area before you have been in the plan for one 
year, AND you immediately join another Medicare Advantage Plan 
or PACE. 

Important: If you have PACE, see the note on page 55. 



59 




Medlgap protections (continued) 

SITUATION #5: You dropped a Medigap policy to join a 
Medicare Advantage Plan or other Medicare Health Plan (or 
to switch to a Medicare SELECT policy) for the first time; 
you have been in the plan less than a year; and you want to 
switch back. 

If the same insurance company still sells it, you have the right to 
go back to the Medigap policy you had. You need to tell the 
Medicare Advantage Plan, other Medicare Health Plan, or 
Medicare SELECT, that you want to leave (disenroll) and give 
them a date to end your coverage. This date must be before you 
have been in the plan for a year. 

If your former Medigap policy isn't available, you have the right 
to buy a Medigap Plan A, B, C, or F (your state might give you 
more choices) that is sold in your state by any insurance 
company. You will have from 60 calendar days before your 
coverage ends until 63 calendar days after your coverage ends to 
apply for a new Medigap policy. 

If your former Medigap policy included prescription drug 
coverage, you have a right to go back to the Medigap policy you 
had, if the same insurance company sells it but you can't get the 
prescription drug coverage back. Even if that Medigap policy is 
available, you also have the right to buy a Medigap Plan A, B, C, 
F, K, or L that is sold in your state by any insurance company. 
You will have from 60 calendar days before your coverage ends 
until 63 calendar days after your coverage ends to apply for a 
new Medigap policy. 

Your rights under this situation may last for an extra 12 months 
if the plan you first joined leaves the Medicare Program or stops 
giving care in your area before you have been in the plan for one 
year, AND you immediately join another Medicare Advantage 
Plan or other Medicare Health Plan. 



60 



ecuon 



MgliriiMffllMM 

Medigap protections (continued) 

SITUATION #6: Your Medigap insurance company goes 
bankrupt and you lose your coverage, or your Medigap policy 
coverage otherwise ends through no fault of your own. 

You have the right to buy a Medigap Plan A, B, C, or F (your state 
might give you more choices) that is sold in your state by any 
insurance company. You will have 63 calendar days from the date 
your coverage ends to apply for a new Medigap policy. Because 
Medigap policies are guaranteed renewable, the only way you 
would lose coverage under a Medigap policy would generally be if 
the Medigap insurance company goes bankrupt or the coverage 
ends through no fault of your own. 



SITUATION #7: You leave a Medicare Advantage Plan, or 
drop a Medigap policy, because the company hasn't followed 
the rules or it misled you. 



In this situation, you leave the Medicare Advantage Plan because 
it failed to meet its contract obligations to you. For example, the 
company isn't paying your claims, or it made untrue statements 
to convince you to buy the policy. Generally, to have this right, 
you must have filed a grievance with the Medicare Advantage 
Plan, Medicare, or your State Insurance Department (see pages 
85-86) and received a decision that the Medicare Advantage Plan 
was at fault. 

You have the right to buy a Medigap Plan A, B, C, or F (your 
state might give you more choices) that is sold in your state by any 
insurance company. You must tell the Medicare Advantage Plan 
that you want to leave (disenroll) and give them a date to end 
your coverage. You will have 63 calendar days from the date your 
coverage ends to apply for a new Medigap policy. 



61 




Haass 



Medigap protections (continued) 



SITUATION #8: You have a Medigap policy that covers 
prescription drugs. You want to enroll in the new Medicare 
prescription drug coverage and switch to another Medigap 
policy that doesn't have prescription drug coverage. 



If you enroll in Medicare prescription drug coverage, you can keep 
your Medigap policy, but you must tell your Medigap insurance 
company to remove the prescription drug coverage from it as of 
the date your Medicare prescription drug coverage starts, and your 
Medigap premium will be adjusted. If you enroll in a Medicare 
Prescription Drug Plan by May 15, 2006, you also have the right 
to switch from the Medigap policy you have now and buy a 
Medigap Plan A, B, C, F (including the high-deductible Plan F), 
K, or L that is sold by your current Medigap insurance company. 
However, you are only guaranteed this right from the same 
insurance company. If you apply to a different insurance company 
they may be able to use medical underwriting. 

You must apply for your new Medigap policy within 63 calendar 
days after your Medicare prescription drug coverage starts. 

If you sign up for a Medicare Prescription Drug Plan after 
May 15, 2006, you will no longer have the right to buy another 
Medigap policy from the same insurance company, unless your 
state has a law that requires it. 

Important: As of January 1, 2006, no new Medigap policies with 
prescription drug coverage can be sold. 

If you have a Medigap policy that covers prescription drugs, you 
will get a notice from your Medigap insurance company every year 
by November 15. This notice describes your options for getting 
prescription drug coverage. Read the entire notice carefully and 
review your options before making any decisions. 

More information about Medicare prescription drug coverage is 
on pages 38-40. 



62 



Section 6: Medigap Rights and Protections 



Medigap protections (continued) 

Special note for people with Medicare under 
age 65 

In most cases, Federal law doesn't require insurance companies to sell 
Medigap policies to people under age 65. However, if an insurance 
company sells a Medigap policy to people under age 65, either 
voluntarily, or because state law requires it, and IF you are in one of 
the situations listed on pages 56-62, the insurance company would 
have to offer you that Medigap policy. 

Note: If you are in a situation where you have a right to return to a 
Medigap policy you used to have, and that Medigap policy included 
prescription drug coverage, you won't be able to get back the 
prescription drug portion of the Medigap policy. 

Where to get more information about 
Medigap protections 

• Call your State Health Insurance Assistance Program (see pages 
85-86) to make sure that you qualify for these Medigap 
protections. They can also help you find the Medigap policy that 
is right for you. 

• Call your State Insurance Department (see pages 85-86) if you are 
denied Medigap coverage in any of these situations. 



63 




Notes 




I used this section to 
learn about my 
Medigap protections. 



64 







Section 7 



Medigap Policies and 
Disability or ESRD 



65 



Section 7: Medigap Policies and Disability or ESRD 



Words in green 
are defined on 
pages 88-91. 



Medigap policies for people under age 65 and 
eligible for Medicare because of a disability or 
End-Stage Renal Disease (ESRD) 

You may have Medicare before age 65 due to 

• a disability, or 

• ESRD (permanent kidney failure requiring dialysis or a kidney 
transplant). 

If you are a person with Medicare under age 65 and are disabled or have 
ESRD, you might not be able to buy the Medigap policy you want (or 
any Medigap policy) until you turn age 65. Federal law doesn't require 
insurance companies to sell Medigap policies to people under age 65. 
However, some states require Medigap insurance companies to sell you a 
Medigap policy, at certain times (during a limited Medigap open 
enrollment period), even if you are under age 65 (see pages 56-62). 
These states are listed below. If you have questions, you should call your 
State Health Insurance Assistance Program (see pages 85-86). 

At the time of printing this guide, the following states required insurance 
companies to offer at least one kind of Medigap policy to people with 
Medicare under age 65: 



• California 

• Colorado 

• Connecticut 

• Hawaii 

• Kansas 

• Louisiana 

• Maine 

• Maryland 

• Massachusetts 



• Michigan 

• Minnesota 

• Mississippi 

• Missouri 

• New Hampshire 

• New Jersey 

• New York 

• North Carolina 

• Oklahoma 



• Oregon 

• Pennsylvania 

• South Dakota 

• Texas 

• Vermont 

• Washington 

• Wisconsin 



66 



Even if your state isn't on this list, some insurance companies may 
voluntarily sell Medigap policies to some people under age 65. Whether 
or not your state requires insurance companies to sell to you, Medigap 
policies sold to people under age 65 may cost you more than policies sold 
to people over age 65. However, some states require that people under 
age 65 who are buying a Medigap policy are given the best price available 
during the Medigap open enrollment period. 

Remember, if you live in a state that has a Medigap open enrollment 
period for people under age 65, you will still get another Medigap open 
enrollment period when you turn age 65. You may have other choices of 
Medigap policies or be able to get a lower premium at that time. 



Section 7: Medigap Policies and Disability or ESRD 



Medigap policies for people under age 65 and 
eligible for Medicare because of a disability or 
End-Stage Renal Disease (ESRD) (continued) 

Also, if you join a Medicare Advantage Plan or other Medicare 
Health Plan and your coverage ends, you may have the right to buy a 
Medigap policy. If you have questions, you should call your State 
Health Insurance Assistance Program (see pages 85—86). 

Medigap policies for people age 65 or older 
and eligible for Medicare because of a 
disability or End-Stage Renal Disease (ESRD) 

The first six months after you turn age 65 and are enrolled in 
Medicare Part B is when you are in your Medigap open enrollment 
period. It doesn't matter that you have had Medicare Part B before 
you turned age 65. During this time 

• you can buy any Medigap policy from any insurance 
company, and 

• insurance companies can't refuse to sell you a Medigap policy due to 
a disability or other health problem, or charge you a higher premium 
(based on health status) than they charge other people who are 65 
years old. 

When you buy a Medigap policy during your Medigap open 
enrollment period, the insurance company must shorten the 
waiting period for pre-existing conditions by the amount of 
creditable coverage you have. If you had Medicare (Part A and/or 
Part B) for more than six months before you turned 65 years old, 
and didn't have a break in coverage of 63 or more days, you won't 
have a pre-existing condition waiting period because Medicare counts 
as creditable coverage. (See page 30 for more information about 
creditable coverage.) 



67 



Section 7: Medigap Policies and Disability or ESRD 




'I wasn't sure if 
I could buy a 
Medigap 
policy, so I 
called my State 
Health 
Insurance 
Assistance 
Program. They 
were very 
helpful and 
answered all of 
my questions." 



Right to suspend a Medigap policy for 
people with Medicare who have a disability 

If you are under age 65, have Medicare, have a Medigap policy, and 
have employer group health plan coverage, you have a right to put 
your Medigap policy on hold ("suspend"). If you want to suspend 
your Medigap policy, you should call your Medigap insurance 
company. Your Medigap coverage will stop, and you don't have to 
pay the monthly premium while you are enrolled in your or your 
spouse's employer group health plan. If you want your Medigap 
policy back (reinstated), you will have to pay a monthly premium. 
You won't have to pay more when you start your Medigap policy 
again than you would otherwise have to pay if you had not 
suspended your policy. 

If, for any reason, you lose your employer group health plan 
coverage, you can get your Medigap policy back. Within 90 days of 
losing your employer group health plan coverage, you must notify 
your Medigap insurance company that you want your Medigap 
policy back. If your Medigap policy included prescription drug 
coverage, you can still get your Medigap policy back but without 
the prescription drug coverage. 

Your Medigap benefits and premiums will start again on the day 
your employer group health plan coverage stops. The Medigap 
policy must have the same benefits and premiums it would have 
had if you had never suspended your coverage. Your Medigap 
insurance company can't refuse to cover care for any pre-existing 
conditions (health problems) you have (see page 29). So, if you are 
disabled and working, you can enjoy the benefits of your employer's 
insurance while knowing that you will be able to get your Medigap 
policy back when you need it. 



68 





Section 8 



Other Ways to Pay 
Health Care Costs 



69 




Other kinds of insurance and ways 
to pay health care costs 

There are other kinds of health care coverage, besides a Medigap policy, 
that may pay some of your health care costs not covered by Medicare. 
The chart on pages 71-77 describes some of the following types of 
insurance and other ways to pay health care costs: 

Page(s) 

COBRA coverage (Consolidated Omnibus Budget 

Reconciliation Act) 71-72 

Drug Discount Cards 72 

Employee or retiree coverage from an employer or union 73 

Federally Qualified Health Centers (FQHCs) 73 

Home and Community-Based Service/Waiver programs 

(HCBS) , 73 

Hospital indemnity insurance 7A 

Long-term care insurance 74 

Medicaid 74-75 

Medicare Savings Programs (help paying Medicare 

premiums) 75 

Military retiree benefits (TRICARE) 76 

PACE (Programs of All-inclusive Care 

for the Elderly) 76 

Prescription drug and other assistance programs 76 

Specified disease insurance 77 

State Children's Health Insurance Program (SCHIP) 77 

Veterans' benefits 77 



70 






ection 8: Other Ways to Pay Health Care Costs 



Types of insurance or 
other ways to pay 
health care costs 



A quick look at how it works 



COBRA 

("Continuation 
Coverage" under the 
Consolidated 
Omnibus Budget 
Reconciliation Act) 
may give you and your 
dependents the right to 
keep your health care 
coverage temporarily if 

• you lose your job, 

• your working hours 
are reduced, 

• you leave your job 
voluntarily, or 

• your employer goes 
bankrupt. 

COBRA may also help 
your dependents 
temporarily keep 
health care coverage if 
you die, and may help 
your spouse 
temporarily keep 
coverage if you get 
divorced. 



If you are covered under an employer or retiree health plan, and you lose 
your coverage for one of the reasons listed in the left-hand column, 
COBRA allows you to keep your coverage for a while longer. However, 
if you also have Medicare you need to know about how COBRA may 
affect some of your choices under Medicare and Medigap. 

When you have COBRA coverage before Medicare starts 

If you already have COBRA when you enroll in Medicare, your 
employer may stop your COBRA coverage entirely, or change the 
length of time your spouse can have coverage under COBRA. 

However, if you have the opportunity to keep your COBRA for a 
while, you might think it's better to keep the COBRA and not start 
paying premiums under Medicare Part B. Here's what you need 
to consider: 

• When you become eligible for Medicare at age 65 you have an 
"Initial Enrollment Period" for Part B. Some people who are still 
working can wait and have a "Special Enrollment Period" after they 
stop working. However, if you or your spouse aren't working, you 
will have to pay more for Part B if you join after your Initial 
Enrollment Period. Therefore, you need to think about signing up 
for Medicare Part B when your employer coverage ends even if you 
elect to get COBRA coverage. You won't get a Special Enrollment 
Period for Medicare Part B after COBRA coverage expires. 

• Enrolling in Part B, regardless of when you enroll after you are age 
65, starts your six-month Medigap open enrollment period. Once 
this period starts, it can't be changed. If you stay on COBRA, and 
enroll in Part B, but decide to wait until after your open enrollment 
period to buy a Medigap policy, you may have trouble buying a 
Medigap policy if you have health problems. 

• Once your open enrollment period ends, the only way you have 
guaranteed rights to buy a Medigap policy is if you have "Medigap 
protections." (See Medigap protections, Situation #2 on page 57.) 

Whatever you decide to do, you need to keep in mind the timeframes 
for getting each type of coverage: 

• For COBRA you have 60 days to sign up for the coverage, beginning 
either the day you lose your employer coverage, or the date of the 
notice that you have COBRA rights, whichever comes later. 



71 



ion 8: Other Ways to Pay Health Care Cos 



Types of insurance or 
other ways to pay 
health care costs 


A quick look at how it works 


COBRA (continued) 


Whatever you decide to do, you need to keep in mind the timeframes 
for getting each type of coverage: (continued) 

• Your Initial Enrollment Period for Medicare Part B starts three 
months before you turn age 65. 

• Your Medigap open enrollment period is the six-month period 
that starts on the first day of the month in which you are both age 
65 or older and enrolled in Medicare Part B. During this period you 
have the right to buy any Medigap policy. 

• For Medigap protections you have 63 days to sign up after you 
find out that your employer coverage has ended. 

• If you decide you want to join a Medicare Advantage Plan or other 
Medicare Health Plan instead of the Original Medicare Plan, there 
may be limits on the times you can enroll. 


Drug discount cards 
may help 

people save money on 
prescription drugs. 


You may have a Medicare-approved drug discount card. Although 
you can no longer get one of these cards, they are good until 
May 15, 2006, or until you enroll in a Medicare drug plan, 
whichever is first. For more information about Medicare-approved 
drug discount cards, visit www.medicare.gov on the web. Select 
"Search Tools" at the top of the page. Or, call 1-800-MEDICARE 
(1-800-633-4227). TTY users should call 1-877-486-2048. 

Drug discount cards and Medigap Policies 

You might have a drug discount card with your Medigap policy. 
This isn't insurance, although these cards can reduce your 
prescription drug costs. 







72 



Section 8: Other Ways to Pay Health Care Costs 



Types of insurance or 
other ways to pay 
health care costs 


A quick look at how it works 


Employee or retiree 
coverage from an 
employer or union may 
help 

employees or spouses 
who have or had health 
care coverage from a 
current or previous 
employer or union. 


In some cases, you or your spouse might be able to get your health care 
coverage from an employer or union based on your or your spouse's 
current employment. This is called "employee coverage." 

Some employers or unions might let you or your spouse continue 
your health care coverage after the employment ends. This is called 
"retiree coverage." 

If you have this type of coverage from an employer or union, they 
may change the benefits or premiums, and may also be able to cancel 
the coverage if they choose. 

If you or your spouse are working and have group health coverage 
based on current or active employment there are special things to 
think about with Part B and Medigap policies. See the information 
about the Medigap open enrollment period on pages 26-28. 

Employee and retiree coverage and Medigap 

If you have employee or retiree coverage and it ends, you may have 
the right to buy a Medigap policy. You may get a notice or claim 
denial letting you know that your health care coverage is ending. You 
have 63 calendar days from the date your coverage ends or from the 
notice or claim denial to apply for a Medigap policy (see Medigap 
protections, Situation #2 on page 57). 


Federally Qualified 
Health Centers 
(FQHCs) may help 

people who live near a 
FQHC 


FQHCs are special health centers, usually located in urban or rural 
areas, that can give routine health care at a lower cost. Some FQHCs 
are Community Health Centers, Tribal FQHC Clinics, Certified 
Rural Health Clinics, Migrant Health Centers, and Health Care for 
the Homeless Programs. 


Home and 

Community-Based 

Service/Waiver 

programs (HCBS) 

may help 

certain elderly and 

disabled individuals. 


HCBS programs are available to some people with Medicaid. They 
offer services and programs that help you get care in your home 
and community. Some examples of this care include homemaker 
services, personal care, adult day care, meals, and transportation. 
These programs help you to stay more independent. 



73 



Section 8: Other Ways to Pay Health Care Costs 



Types of insurance or 
other ways to pay 
health care costs 



A quick look at how it works 



Hospital indemnity 
insurance may help 

pay for hospital stays 
up to a certain 
number of days. 



This kind of insurance pays a set amount of money for each day of 
a hospital stay. This insurance doesn't fill gaps in your Medicare 
coverage. It usually pays in addition to your health insurance. 



Long-term care 
insurance may help 

pay for your health or 
personal care needs 
and activities of daily 
living, such as 
bathing, dressing, 
using the bathroom, 
and eating. 



Long-term care insurance is sold by private insurance companies 
and usually covers medical care and non-medical care. Make sure 
you choose the long-term care insurance policy that meets your 
needs. 

For information about long-term care insurance, get a copy of "A 
Shopper's Guide to Long-Term Care Insurance" from either your 
State Insurance Department (see pages 85-86) or the National 
Association of Insurance Commissioners, 2301 McGee Street, 
Suite 800, Kansas City, MO 64108-3600. Or, call your State 
Health Insurance Assistance Program (see pages 85—86). 



Medicaid may help 

people with limited 
incomes and resources. 



Medicaid helps pay your medical costs. Since Medicaid is a joint 
Federal and state program, coverage varies from state to state. 

People with Medicaid may get coverage for things like nursing 
home care and home care that aren't covered by Medicare. 

Starting in 2006, people with Medicare who also qualify for 
Medicaid will no longer have most outpatient prescription drugs 
covered by Medicaid. Instead, prescription drugs will be covered 
through Medicare drug plans. 

Medicaid and Medigap 

If you have a Medigap policy and then get Medicaid, there are a 
few things you should know: 

• You can put your Medigap policy on hold ("suspend") within 
90 days of getting Medicaid. 

• You won't have to pay your Medigap policy premiums while it 
is suspended. 



74 






Section 8: Other Ways to Pay Health Care Costs 







Types of insurance or 
other ways to pay 
health care costs 


A quick look at how it works 


Medicaid (continued) 


• Your Medigap policy won't pay benefits while it is suspended. 

• You can suspend a Medigap policy for up to two years. 

• At the end of the suspension, you can restart the Medigap policy 
without new medical underwriting or pre-existing condition 
waiting periods. 

• As of January 1, 2006, if you suspend your Medigap policy and 
it includes prescription drug coverage, you can still get the 
Medigap policy back but without the prescription drug coverage. 

To help you make a decision about suspending a Medigap policy, call 
your State Medical Assistance Office. To get their telephone number, 
call 1-800-MEDICARE (1-800-633-4227). TTY users should call 
1-877-486-2048. For questions about suspending a Medigap policy, 
call your Medigap insurance company 

If you already have health insurance coverage through your state 
Medicaid program, an insurance company can sell you a Medigap 
policy only if 

• Medicaid pays your Medigap policy premium, or 

• Medicaid only pays your Medicare Part B premium. 

In any other situation, it is illegal for an insurance company to sell you 
a Medigap policy if you are getting any Medicaid benefits. 


Medicare Savings 
Programs (help from 
Medicaid paying 
Medicare premiums) 
may help 

people with limited 
income and resources. 


These programs can help pay your Medicare premiums and, in some 
cases, may also pay Medicare deductibles and coinsurance. To be 
eligible for this program, you must meet certain requirements. 

These programs may not be available in Guam, Puerto Rico, the 
Virgin Islands, the Northern Mariana Islands, and American Samoa. 

To find out if these programs are available in your area or for more 
information, call your State Medical Assistance Office. To get their 
telephone number, call 1-800-MEDICARE (1-800-633-4227). TTY 
users should call 1-877-486-2048. Since the names of these programs 
may vary by state, ask for information on Medicare Savings Programs. 



75 







Section 8: Other Ways to Pay Health Care Costs 














Types of insurance or 
other ways to pay 
health care costs 


A quick look at how it works 






Military retiree 
benefits (TRICARE) 
may help 

active duty and retired 
uniformed services 
members and their 
families. 


TRICARE is a health care program that offers medical coverage to 
eligible members. The TRICARE Program includes TRICARE 
Prime, TRICARE Extra, TRICARE Standard, and TRICARE for 
Life (TFL). 

If eligible, you get all Medicare-covered benefits under the Original 
Medicare Plan, plus all TFL-covered benefits. 

For more information about the TRICARE Programs, call 
1-800-538-9552 or visit www.tricare.osd.mil on the web. 




PACE (Programs of 
All-inclusive Care for 
the Elderly) may help 

frail people who live in 
the service area of 
PACE. 


PACE combines medical, social, and long-term care services for frail 
people. PACE might be a better choice for you than getting your 
care through a nursing home. PACE is available only in states that 
have chosen to offer it under Medicaid. If you live in a state that 
offers PACE, and you have Medicare and are eligible for PACE, you 
can choose to get your Medicare benefits through this program. 

To find out if you are eligible and if there is a PACE site near you, or 
for more information, call your State Medical Assistance Office. To 
get their telephone number call 1-800-MEDICARE 
(1-800-633-4227). TTY users should call 1-877-486-2048. Or, visit 
www.medicare.gov or www.cms.hhs.gov/pace/pacesite.asp on the web. 






Prescription drug and 
other assistance 
programs may help 

people get discounted 
or free prescription 
drugs. 


Some states have programs that may offer lower cost or free 
prescription drugs. They may also have other assistance programs to 
help pay for your other health care costs. To be eligible for these 
programs, you must meet certain requirements. For more 
information, visit www.medicare.gov on the web. Select "Search 
Tools" at the top of the page. Or, call 1-800-MEDICARE 
(1-800-633-4227). TTY users should call 1-877-486-2048. 

















76 



Section 8: Other Ways to Pay Health Care Costs 



Types of insurance or 
other ways to pay 
health care costs 


A quick look at how it works 


Specified disease 
insurance may help 

people with a certain 
type of disease. 


Specified disease insurance pays benefits for a single disease, such as 
cancer, or for a group of diseases. You usually have to buy this 
insurance before you are diagnosed or treated for the 
specified disease. 

This insurance doesn't fill gaps in your Medicare coverage. It usually 
pays in addition to your health insurance. 


State Children's Health 
Insurance Program 
(SCHIP) may help 

uninsured children under 
age 19, and some adults. 


Some states offer free or low-cost health insurance to uninsured 
children and some adults whose families don't qualify for Medicaid. 
For more information about your state's program, visit 
www.cms.hhs.gov/home/schip.asp on the web. 


Veterans' benefits 
may help 

people who have had 
any military service or 
are veterans. 


The U.S. Department of Veterans Affairs offers health care 
benefits and other types of benefits and services to eligible 
members. For more information about VA benefits and services, 
call the U.S. Department of Veterans Affairs at 1-800-827-1000. 



77 











VH 


Notes 










- 
















































- 
















. 




































































1 used this section to 
learn the different ways 
to pay for health care." 



78 




Section 9 



Massachusetts, 
Minnesota, and 
Wisconsin 
Medigap Plans 



79 



Section 9: Massachusetts, Minnesota, Wisconsin Medigap Plans 



Massachusetts — Chart Of Standardized 

Medigap Plans 

Basic benefits included in all plans: 

• Inpatient Hospital Care: Covers the Medicare Part A coinsurance and the cost of 365 
extra days of hospital care during your lifetime after Medicare coverage ends. 

• Medical Costs: Covers the Medicare Part B coinsurance (generally 20% of the 
Medicare-approved payment amount). 

• Blood: Covers the first three pints of blood each year. 



Medigap Benefits 


Core 
Plan 


Supplement 
1 Plan 


Basic Benefits 


/ 


/ 


Medicare Part A: Inpatient 
Hospital Deductible 




/ 


Medicare Part A: Skilled Nursing 
Facility Coinsurance 




/ 


Medicare Part B: Deductible 




/ 


Foreign Travel 
Emergency 




/ 


Inpatient Days in Mental 
Health Hospitals 


60 days per 
calendar year 


120 days per 
benefit year 


State-Mandated Benefits 
(Annual Pap tests and 
mammograms. Check your plan 
for other state-mandated benefits.) 


/ 


/ 



For more information on these policies, call your State Insurance Department (see pages 
85-86) or visit www.medicare.gov on the web. Select "Search Tools" at the top of the page. 

Note: The check marks in this chart mean the benefit is covered under that plan. 



80 



Section 9: Massachusetts, Minnesota, Wisconsin Medigap Plans 



Minnesota — Chart Of Standardized 

Medigap Plans 

Basic benefits included in all plans: 

• Inpatient Hospital Care: Covers the Medicare Part A coinsurance. 

• Medical Costs: Covers the Medicare Part B coinsurance (generally 20% of 
the Medicare-approved payment amount). 

• Blood: Covers the first three pints of blood each year. 



Medigap Benefits 


Basic Plan 


Extended 
Basic Plan 


Basic Benefits 


/ 


/ 


Medicare Part A: Inpatient 
Hospital Deductible 




/ 


Medicare Part A: Skilled 
Nursing Facility Coinsurance 


/ 


/ 


Medicare Part B: Deductible 




/ 


Foreign Travel Emergency 


80% 


80%* 


Outpatient Mental Health 


50% 


50% 


Usual and Customary Fees 




80%* 


Preventive Care 


/ 


/ 


At-home Recovery 




/ 


Physical Therapy 


20% 


20% 


Coverage while in a 
Foreign Country 




80%* 


State-Mandated Benefits 
(Diabetic equipment 
and supplies, routine cancer 
screening, reconstructive surgery, 
and immunizations.) 


/ 


/ 



Optional Riders 



• Medicare Part A: 
Inpatient Hospital 
Deductible 

• Medicare Part B: 
Deductible 

• Usual and 
Customary Fees 

• Preventive Care 

• At-home recovery 

Insurance companies 
are allowed to offer six 
additional riders that 
can be added to a Basic 
Plan. You may choose 
any one or all of the 
riders to design a 
Medigap policy that 
meets your needs. 



The policy pays 100% after you spend $1000 of out-of-pocket expenses for a calendar year. 
Note: The check marks in this chart mean the benefit is covered under that plan. 



81 



Section 9: Massachusetts, Minnesota, Wisconsin Medigap Plans 



Wisconsin — Chart Of Standardized 

Medigap Plans 

Basic benefits included in all plans: 

• Inpatient Hospital Care: Covers the Medicare Part A coinsurance. 

• Medical Costs: Covers the Medicare Part B coinsurance (generally 20% of 
the Medicare-approved payment amount). 

• Blood: Covers the first three pints of blood each year. 



Medigap Benefits 


Basic Plan 


Basic Benefits 


/ 


Medicare Part A: 
Skilled Nursing Facility 
Coinsurance 


/ 


Inpatient Mental 
Health Coverage 


175 days per lifetime in 
addition to Medicare 


Home Health Care 


40 visits in addition to 
those paid by Medicare 


Outpatient Mental Health 


/ 



Optional Riders 



• Medicare Part A Deductible 

• Additional Home Health Care 
(365 visits including those paid 
by Medicare) 

• Medicare Part B Deductible 

• Medicare Part B Excess Charges 

• Foreign Travel 

Insurance companies are allowed 
to offer additional riders to a 
Medigap policy. 



For more information on these policies, call your State Insurance Department (see pages 
85-86) or visit www.medicare.gov on the web. Select "Search Tools" at the top of the page. 

Note: The check marks in this chart mean the benefit is covered under that plan. 



82 




Section 10 



For More Information 



83 



Section 10: For More Information 



Words in green 
are defined on 
pages 88-91. 



On pages 85-86, you will find telephone numbers for your State 
Health Insurance Assistance Program and State Insurance 
Department. These telephone numbers were correct at the time of 
printing. Telephone numbers sometimes change. You can find the 
most up-to-date telephone numbers by visiting www.medicare.gov 
on the web. Select "Search Tools" at the top of the page. Or, call 
1-800-MEDICARE (1-800-633-4227). TTY users should call 
1-877-486-2048. 

Where to get more information 

• Call your State Health Insurance Assistance Program (see pages 
85-86) for help with 

■ buying a Medigap policy or long-term care insurance, 

■ dealing with payment denials or appeals, 

■ Medicare rights and protections, 

■ choosing a Medicare plan, 

■ deciding whether to suspend your Medigap policy, or 

■ questions about Medicare bills. 

• Call your State Insurance Department (see pages 85-86) if you 
have questions about the Medigap policies sold in your area or any 
insurance-related problems. 

Where to call with Medicare questions 

If you have questions about Medicare, call 1-800-MEDICARE 
(1-800-633-4227). Customer service representatives are available 
24 hours a day, seven days a week. TTY users should call 
1-877-486-2048. 



84 



Section 10: For More Information 



State 


State Health Insurance 
Assistance Program 


State Insurance 
Department 


Alabama 


1-800-243-5463 


1-800-433-3966 


Alaska 


1-800-478-6065 


1-800-467-8725 


American Samoa 


Not Available 


1-684-633-4116 


Arizona 


1-800-432-4040 


1-800-325-2548 


Arkansas 


1-800-224-6330 


1-800-282-9134 


California 


1-800-434-0222 


1-800-927-4357 


Colorado 


1-888-696-7213 


1-800-930-3745 


Connecticut 


1-800-994-9422 


1-800-203-3447 


Delaware 


1-800-336-9500 


1-800-282-8611 


Florida 


1-800-963-5337 


1-800-342-2762 


Georgia 


1-800-669-8387 


1-800-656-2298 


Guam 


Not Available 


1-671-475-1817 


Hawaii 


1-888-875-9229 


1-808-586-2790 


Idaho 


1-800-247-4422 


1-800-721-3272 


Illinois 


1-800-548-9034 


1-866-445-5364 


Indiana 


1-800-452-4800 


1-800-622-4461 


Iowa 


1-800-351-4664 


1-800-351-4664 


Kansas 


1-800-860-5260 


1-800-432-2484 


Kentucky 


1-877-293-7447 


1-800-595-6053 


Louisiana 


1-800-259-5301 


1-800-259-5300 


Maine 


1-877-353-3771 


1-800-300-5000 


Maryland 


1-800-243-3425 


1-800-492-6116 


Massachusetts 


1-800-243-4636 


1-617-521-7794 


Michigan 


1-800-803-7174 


1-877-999-6442 


Minnesota 


1-800-333-2433 


1-800-657-3602 


Mississippi 


1-800-948-3090 


1-800-562-2957 


Missouri 


1-800-390-3330 


1-800-726-7390 


Montana 


1-800-551-3191 


1-800-332-6148 


Nebraska 


1-800-234-7119 


1-800-234-7119 



85 



Section 10: For More Information 



State 


State Health Insurance 
Assistance Program 


State Insurance 
Department 


Nevada 


1-800-307-4444 


1-800-992-0900 


New Hampshire 


1-800-852-3388 


1-800-852-3416 


New Jersey 


1-800-792-8820 


1-800-446-7467 


New Mexico 


1-800-432-2080 


1-800-947-4722 


New York 


1-800-333-4114 


1-800-342-3736 


North Carolina 


1-800-443-9354 


1-800-546-5664 


North Dakota 


1-888-575-6611 


1-800-247-0560 


Northern Mariana 
Islands 


Not Available 


1-670-664-3017 


Ohio 


1-800-686-1578 


1-800-686-1578 


Oklahoma 


1-800-763-2828 


1-800-522-0071 


Oregon 


1-800-722-4134 


1-888-877-4894 


Pennsylvania 


1-800-783-7067 


1-877-881-6388 


Puerto Rico 


1-877-725-4300 


1-888-722-8686 


Rhode Island 


1-401-462-4000 


1-401-222-2223 


South Carolina 


1-800-868-9095 


1-800-768-3467 


South Dakota 


1-800-536-8197 


1-877-310-6560 


Tennessee 


1-877-801-0044 


1-800-342-4029 


Texas 


1-800-252-9240 


1-800-252-3439 


Utah 


1-800-541-7735 


1-866-350-6242 


Vermont 


1-800-642-5119 


1-800-631-7788 


Virgin Islands 


1-340-772-7368 (St.Croix) 
1-340-714-4354 


1-340-773-6449 


Virginia 


1-800-552-3402 


1-877-310-6560 


Washington 


1-800-562-6900 


1-800-562-6900 


Washington D.C. 


1-202-739-0668 


1-202-727-8000 


West Virginia 


1-877-987-4463 


1-888-879-9842 


Wisconsin 


1-800-242-1060 


1-800-236-8517 


Wyoming 


1-800-856-4398 


1-800-438-5768 



86 




Section 11 



Words to Know 



87 



Section 11: Words to Know 



Assignment — In the Original Medicare 
Plan, this means a doctor or supplier agrees 
to accept the Medicare-approved amount as 
full payment. If you are in the Original 
Medicare Plan, it can save you money if 
your doctor accepts assignment. You still pay 
your share of the cost of the doctor's visit. 

Benefit Period — The way that the Original 
Medicare Plan measures your use of hospital 
and skilled nursing facility (SNF) services. A 
benefit period begins the day you go to a 
hospital or skilled nursing facility. The benefit 
period ends when you haven't received any 
hospital care (or skilled care in a SNF) for 60 
days in a row. If you go into the hospital or a 
SNF after one benefit period has ended, a 
new benefit period begins. You must pay the 
inpatient hospital deductible for each benefit 
period. There is no limit to the number of 
benefit periods you can have. 

Coinsurance — The amount you may be 
required to pay for services after you pay any 
plan deductibles. In the Original Medicare 
Plan, this is a percentage (like 20%) of the 
Medicare-approved amount. You have to pay 
this amount after you pay the deductible for 
Part A and/or Part B. In a Medicare drug 
plan, the coinsurance will vary depending on 
how much you have spent. 

Copayment — In some Medicare health and 
prescription drug plans, the amount you pay 
for each medical service, like a doctor's visit, 
or prescription. A copayment is usually a set 
amount you pay. For example, this could be 
$ 1 or $20 for a doctor's visit or 
prescription. Copayments are also used for 
some hospital outpatient services in the 
Original Medicare Plan. 



Creditable Coverage (Medigap) — Certain 
kinds of previous health insurance coverage 
that can be used to shorten a pre-existing 
condition waiting period under a Medigap 
policy. (See pre-existing conditions.) 

Deductible — The amount you must pay for 
health care or prescriptions, before Original 
Medicare, your prescription drug plan, or 
other insurance begins to pay. For example, 
in Original Medicare, you pay a new 
deductible for each benefit period for 
Medicare Part A, and each year for Medicare 
Part B. These amounts can change every year. 

End-Stage Renal Disease (ESRD) — 

Permanent kidney failure that requires a 
regular course of dialysis or a kidney 
transplant. 

Excess Charges — If you are in the Original 
Medicare Plan, this is the difference between 
a doctor's or other health care provider's 
actual charge (which may be limited by 
Medicare or the state) and the 
Medicare-approved payment amount. 

Guaranteed Issue Rights (also called 
"Medigap Protections") — Rights you have - 
in certain situations when insurance 
companies are required by law to sell or offer 
you a Medigap policy. In these situations, an 
insurance company can't deny you a policy, 
or place conditions on a policy, such as 
exclusions for pre-existing conditions, and 
can't charge you more for a policy because of 
past or present health problems. 

Guaranteed Renewable — A right you have 
that requires your insurance company to 
automatically renew or continue your 
Medigap policy, unless you make untrue 
statements to the insurance company, 
commit fraud or don't pay your premiums. 



88 



Section 1 1 : Words to Know 



Health Maintenance Organization (HMO) 
Plan (Medicare) — A type of Medicare 
Advantage Plan that is available in some 
areas of the country. Plans must cover all 
Medicare Part A and Part B health care. 
Some HMOs cover extra benefits, like extra 
days in the hospital. In most HMOs, you 
can only go to doctors, specialists, or 
hospitals on the plan's list except in an 
emergency. Your costs may be lower than in 
the Original Medicare Plan. 

Hospice Care — A special way of caring for 
people who are terminally ill. Hospice care 
involves a team-oriented approach that 
addresses the medical, physical, social, 
emotional and spiritual needs of the patient. 
Hospice also provides support to the 
patient's family or caregiver as well. Hospice 
care is covered under Medicare Part A 
(Hospital Insurance). 

Lifetime Reserve Days — In the Original 
Medicare Plan, a total of 60 extra days that 
Medicare will pay for when you are in a 
hospital more than 90 days during a benefit 
period. Once these 60 reserve days are used, 
you don't get any more extra days during your 
lifetime. For each lifetime reserve day, 
Medicare pays all covered costs except for a 
daily coinsurance ($476 in 2006). 

Long-term Care — A variety of services that 
help people with health or personal needs 
and activities of daily living over a long 
period of time. Long-term care can be 
provided at home, in the community, or in 
various types of facilities, including nursing 
homes and assisted living facilities. Most 
long-term care is custodial care. Medicare 
doesn't pay for this type of care if this is the 
only kind of care you need. 



Medicaid — A joint Federal and state 
program that helps with medical costs for 
some people with low incomes and limited 
resources. Medicaid programs vary from 
state to state, but most health care costs are 
covered if you qualify for both Medicare 
and Medicaid. 

Medical Underwriting — The process that 
an insurance company uses to decide, based 
on your medical history, whether or not to 
take your application for insurance, whether 
or not to add a waiting period for 
pre-existing conditions (if your state law 
allows it), and how much to charge you for 
that insurance. 

Medically Necessary — Services or supplies 
that are needed for the diagnosis or 
treatment of your medical condition, meet 
the standards of good medical practice in the 
local area, and aren't mainly for the 
convenience of you or your doctor. 

Medicare Advantage Plan — A plan offered 
by a private company that contracts with 
Medicare to provide you with all your 
Medicare Part A and Part B benefits. 
Medicare Advantage Plans are HMOs, 
PPOs, or PFFSs Plans. If you are enrolled in 
a Medicare Advantage Plan, Medicare 
services are covered through the plans, and 
aren't paid for under Original Medicare. 

Medicare-approved Amount — In the 

Original Medicare Plan, this is the amount a 
doctor or supplier can be paid, including 
what Medicare pays and any deductible, 
coinsurance, or copayment that you pay. It 
may be less than the actual amount charged 
by a doctor or supplier. 



89 



Section 11: Words to Know 



Medicare Prescription Drug Plan — A 

stand-alone drug plan, offered by insurers 
and other private companies to beneficiaries 
that get their Medicare Part A and/or Part B 
benefits through the Original Medicare Plan; 
Medicare Private Fee-for-Service Plans that 
don't offer prescription drug coverage; and 
Medicare Cost Plans offering Medicare 
prescription drug coverage. 

Medicare SELECT — A type of Medigap 
policy that may require you to use hospitals 
and, in some cases, doctors within its 
network to be eligible for full benefits. 

Medigap Policy — Medicare supplement 
insurance sold by private insurance 
companies to fill "gaps" in Original 
Medicare Plan coverage. Except in 
Massachusetts, Minnesota, and Wisconsin, 
there are up to 12 standardized policies 
labeled Plan A through Plan L. Medigap 
policies only work with the Original 
Medicare Plan. Medigap policies may also 
be called Medicare Supplement Insurance. 
They are called Medicare SELECT policies 
if they require people with Medicare to use 
network providers in order to get full 
supplemental benefits. 

Open Enrollment Period (Medigap) — A 

one-time-only six month period when you 
can buy any Medigap policy you want that 
is sold in your state. It starts in the first 
month that you are covered under Medicare 
Part B and you are age 65 or older (or under 
age 65 in some states). During this period, 
you can't be denied coverage or charged 
more due to past or present health problems. 



Original Medicare Plan — A fee-for-service 
health plan that lets you go to any doctor, 
hospital, or other health care supplier who 
accepts Medicare and is accepting new 
Medicare patients. You must pay the 
deductible. Medicare pays its share of the 
Medicare-approved amount, and you pay 
your share (coinsurance). In some cases you 
may be charged more than the 
Medicare-approved amount. The Original 
Medicare Plan has Part A (Hospital 
Insurance) and Part B (Medical Insurance). 

Pre-existing Condition — A health problem 
you had before the date that a new insurance 
policy starts. 

Preferred Provider Organization (PPO) 
Plan (Medicare) — A type of Medicare 
Advantage Plan in which you pay less if you 
use doctors, hospitals, and providers that 
belong to the plan's network. You can use 
doctors, hospitals, and providers outside of 
the network for an additional cost. 

Premium — The periodic payment to 
Medicare, an insurance company, or a health 
care plan for health care or prescription 
drug coverage. 

Private Fee-for-Service (PFFS) Plan — A 

type of Medicare Advantage Plan in which 
you may go to any Medicare-approved 
doctor or hospital that accepts the plan's 
payment. The insurance plan, rather than 
the Medicare Program, decides how much it 
will pay and what you pay for the services 
you get. You may pay more or less for 
Medicare-covered benefits. You may have 
extra benefits the Original Medicare Plan 
doesn't cover. 



90 






ection 1 1 : Words to Know 



Programs of All-inclusive Care for the 
Elderlv (PACE) — PACE combines medical, 
social, and long-term care services lor frail 
people ro help people stay independent and 
living in their community as long as 
possible, while getting the high-quality care 
they need. PACE is available only in states 
that have chosen to ofrer it under Medicaid. 
To be eligible, you must 

• be 55 years old or older, 

• live in the service area of the PACE 
program. 

• be certified as eligible lor nursing home 
care by the appropriate state agency, and 

• be able to live safely in the community. 

Skilled Nursing Facility — A nursing 
facility with the start and equipment to give 
skilled nursing care and/or skilled 
rehabilitation services and other related 
health services. 

Skilled Nursing Facility Care — This is a 
level of care that requires the daily 
involvement of skilled nursing or 
rehabilitation staff and that, as a practical 
matter, cant be provided on an outpatient 
basis. Examples of skilled nursing lacilitv 
care include intravenous injections and 
physical therapy. The need for custodial care 
(for example, assistance with activities of 
daily living;, like bathing and dressing) 
cannot, in itself, qualify you lor Medicare 
coverage in a skilled nursing facility. 
However, it vou qualify for coverage based 
on your need lor skilled nursing or 
rehabilitation. Medicare will cover all of 
your care needs in the facility, including 
assistance with activities of daily living. 



Special Needs Plan — A special type of plan 
that provides more focused health care for 
specific groups of people, such as those who 
have both Medicare and Medicaid, who 
reside in a nursing home, or who have 
certain chronic medical conditions. 

State Health Insurance Assistance 
Program — A State program that gets money 
from the federal government to give free 
local health insurance counseling to people 
with Medicare. 

State Insurance Department — A State 

agency that regulates insurance and can 
provide information about Medigap policies 
and other private insurance. 

State Medical Assistance Office — A State 
agency that is in charge of the state's 
Medicaid program and can give information 
about programs that help pay medical bills 
for people with low incomes. 



91 



M 



Notes 




"I keep this book on my 
shelf so I know where to 
find it if I have a question. 



92 




Section 12 



List of Topics 




93 



Section 12: List of Topics 



TIP: Use the "Table of Contents" on pages 1—2 to help you find 
the sections you want to read. 



Assignment 15, 34, 88 

At-Home Recovery 20, 47, 81 

Attained-Age- Rated Policies 22, 23 

B 

Basic Benefits 

Plans A through J 18, 43 

Plans K and L 19, 44, 45 

Benefit Period 15, 48, 88 

Blood 15, 18, 19,43,45,80-82 

C 

Changing (Switching) Medigap Policies 32 

Coinsurance 9, 18-21, 44, 46, 48, 75, 80-82, 88 

Consolidated Omnibus Budget Reconciliation Act (COBRA) ...... 57, 71, 72 

Copayment 9, 15, 18, 19, 43, 44, 88 

Cost/Pricing Policies 22, 23 

Creditable Coverage (Medigap) 26, 30, 31, 88 

D 

Deductible 9, 15, 18-21, 24, 43, 46-48, 75, 80-82, 88 

Delaying Part B Enrollment 28 

Disability 66-68 

Drug Discount Cards 72 

E 

Employee Coverage 30, 73 

Employer Group Health Plan 55, 57, 68, 73 

End-Stage Renal Disease (ESRD) 16, 26, 66, 67, 88 

Excess Charges 15, 20, 46, 82, 88 

Extra Benefits 

Plans B through J 20, 46, 47 

Plans K and L.. 21, 48 

F 

Federally Qualified Health Centers 73 

Finding Reliable Insurance Companies 36 

Foreign Travel Emergency 20, 24, 47, 80-82 



94 



Section 12: List of Topics 



G 

General Enrollment Period (Part B) 28 

Guaranteed Issue Rights 29, 54-62, 88 

Guaranteed Renewable 13, 33, 88 

H 

Health Maintenance Organization Plan 9, 89 

High-Deductible Option 24 

Home and Community-Based Service/Waiver Programs (HCBS) 73 

Hospice Care 19, 45, 89 

Hospital Indemnity Insurance 30, 74 

I 

Initial Enrollment Period 28 

Inspector General's Office 35 

Issue-Age-Rated Policies 22, 23 

L 

Lifetime Reserve Days 43, 44, 89 

Long-Term Care (Insurance) 30, 74 

M 

Medicaid 14, 30, 35, 74, 75, 77, 89 

Medical Underwriting 24, 27, 75, 89 

Medically Necessary 8, 89 

Medicare Advantage Plan 9, 10, 13, 55, 56, 58-61, 67, 89 

Medicare-Approved Amount 15, 43-47, 89 

Medicare-Approved Drug Discount Card 72 

Medicare Part A (Hospital Insurance) 8-10, 13, 16-20, 26, 30 

43, 44, 46, 80-82 
Medicare Part B (Medical Insurance) 8-10, 13-20, 26, 28, 30, 43 

44, 46, 47, 80-82 

Medicare Prescription Drug Plan 39, 40, 90 

Medicare Savings Programs 75 

Medicare SELECT 16, 20, 21, 25, 55, 60, 90 

Medicare Supplement Insurance (see Medigap) 



95 



Section 12: List of Topics 



M (continued) 

Medigap 

Basic Benefits 

Plans A through J 18, 43 

Plans K and L 19, 44, 45 

Extra Benefits 

Plans B through J 20, 46, 47 

Plans K and L 21, 48 

Steps To Buying 42-52 

Under age 65 66-68 

What It Is 12, 13, 90 

What's Covered and What's Not Covered 16, 19 

When To Buy 26-28 

Why You Might Need It 14, 15 

Medigap Benefits Chart 

For Plans A through J 18, 20, 43, 46, 47 

For Plans K and L 19, 21, 44, 45, 48 

For Massachusetts 80 

For Minnesota 81 

For Wisconsin 82 

Medigap Policies and Medicare Prescription Drug Plans 38-40 

Medigap Protections 54-62 

Military Retiree Benefits 76 

N 

No-Age-Rated Policies 22, 23 

O 

Open Enrollment Period (Medigap) 26-29, 54, 66, 67, 90 

Original Medicare Plan 9, 10, 90 

Other Ways to Pay Health Care Costs 70-77 



PACE (Programs of All-inclusive Care for the Elderly) 55, 58-60 

76,91 

Pre-existing Condition 24, 26, 29, 31, 50, 54, 67, 75, 90 

Preferred Provider Organization Plan 9, 90 

Premium 10, 13, 22, 23, 32, 33, 90 

Prescription Drug Coverage (Medicare) 4, 5, 38-40, 62 

Preventive Services (Care) 20, 47 

Pricing Policies 22, 23 

Private Fee-for-Service Plan 9, 90 



96 



C.-JO U.S. GOVERNMENT PRINTING OFFICE: 2006—547-3 



Section 12: List of Topics 



Reliability 36 

Retiree Coverage 73 

s 

Skilled Nursing Facility (Care) 15, 20, 21, 46, 48, 91 

Special Enrollment Period (Medicare Part B) 28 

Special Needs Plan 9, 91 

Specified Disease Insurance 30, 77 

Standardized Medigap Plans 

Plans A through J 18, 20, 43, 46, 47 

Plans K and L 19, 21, 44, 45, 48 

For Massachusetts 80 

For Minnesota 81 

For Wisconsin 82 

State Children's Health Insurance Program 77 

State Health Insurance Assistance Program 6, 20, 21, 36, 38, 49 

54, 66, 85, 86, 91 

State Insurance Department 20, 21, 35, 36, 49, 52, 54, 85, 86, 91 

State Medical Assistance Office 76, 91 

Switching Medigap Policies 32 

T 

TRICARE 30,76 

U 

Union Coverage 30, 57, 73 

V 

Veterans' Benefits 77 

W 

Waiting Period 31, 67 

"Welcome to Medicare" Physical Exam 15, 47 

www. medicare. gov 4, 6, 49 



Note: The information, telephone numbers, and web addresses in this 
"Guide" were correct at the time of printing. Changes may occur after 
printing. To get the most up-to-date information and Medicare telephone 
numbers, visit www.medicare.gov on the web. Or, call 1-800-MEDICARE 
(1-800-633-4227). TTY users should call 1-877-486-2048. 



97 



CMS LIBRARY 



U.S. DEPARTMENT OF 1111111111 

HEALTH AND HUMAN SERVICES 3 adis dddiidl3 i 

Centers for Medicare & Medicaid Services 

7500 Security Boulevard 
Baltimore, Maryland 21244-1850 



Official Business 

Penalty for Private Use, $300 

CMS Pub. No. 02110 
Revised February 2006 



y- 



If you need a copy of this publication in Spanish or in large 
print (English) you can visit www.medicare.gov on the web. 
centers hr medicares, medicaid SERVICES / You can also call 1 -800-MEDICARE ( 1 -800-633-4227) to 

find out if this publication is available in print, on Audiotape, 
and in Braille. TTY users should call 1-877-486-2048. 

^Necesita una copia en espafiol? Visite www.medicare.gov en 
el sitio Web. Para saber si esta publicacion esta impresa y 
disponible (en espafiol), llame GRATIS al 1-800-MEDICARE 
(1-800-633-4227). Los usuarios de TTY deben llamar al 
1-877-486-2048.